HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: n Permit Number:
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Building Permit Application
Planning and Development Services ) q
Building and Code Regulation Division Commercial Residential / (/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462- 1553 Fax : (772) 462-1578 C13DG Funding
PERMIT APPLICATION FOR ;
PROPQSR_ IMpROUEMENTLOCI1l0,N ,
Address: 3raSt LW' POCKAcje Ind �� P1 3` 91
Property Tax ID #: � lL5ca " 5WIO ' ubkq ' 000 - $ Lot No . 10
Site Plan Name :1 ' w j � W akyz S S/ p L&+. ) 0 Block No .
project Name : 3-at,Lw Sa bon ro
Ia �TRILED DESCRIPTION OF, 1NOR C
a
Vz� ta ca 301 VmdovU avid S Doay- S
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRt l�TMzl 1NFOR1�IA710N
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Additional work to be performed under this permit check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction : Sq. Ft. of First Floor:
Cost of Construction : , ? a(020 - 00 Utilities: _ Sewer _ Septic Building Height:
OWNER1LS>F� '.; . _ ANTR,AClOR ,. .
Name Oti o j� o Name: IICA
Address: �Jl tNi � 96C�Q4 WJ Company: a rkLt IIS2 CykirI 0r.S _
City: jxLLi State: '�' L Address: 1 h l I (SOY `dr,-alf. QVIVt
Zip Code : ` 44 02 L>j Fax: City: r�0 � 11� DYt Clt I Stater
Phone No. "103 y OS ggoN9 �j E- Zip Code : ?3Ua l c Fax:
Mail : K kV61120�2 Cf304 LaC+E rLL* Phone No ' CQt 133 6 3 0 0
Fill in fee simple Title Holder on next page (if different E-Mali Y7 •g y ,4' . Daf-ctol xK C YY0(
from the Owner listed above) State or County License WI> t IS 04 1 2-
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVIENTALONSTRUCTIONUEN LAW INFORMATION
DESIGNER/ENGINEER : ^ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name : Name :
Address : Address:
City: State : City: State :
Zip : Phone Zip : Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name : Name :
Address : Address:
City: City:
Zip : Phone : Zip : Phone :
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated .
I certify that no work or Installation has commenced prior to the Issuance of a permit.
St. Lucie County makes no representation that Is ranting a permit will authorize the permit holder to build the subject structure
which conflicts with only app!'cable HomeownersgAssociatIon rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu twit your Homeowners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St .
Lucie County and posted on the jobsite before the first inspection . If you intend to obtain financing, consult
with lender or an attorne before commencin work or recordin our Notice of Commencement.
'Signature of Owner/ LesseelVontractor as Agent for Owner
STATE OF FLOR
COUNTY OF n CHJ n
Sworn to or affirme ) and ►su scribed before me of Physical Presence or _ Online Notarization
this f � ayof 20Zf_ by
Name of person making statement.
Personally Known OR Produced Identification V
Type of Identification Produced Qr2f) t5 U[ 6e 2$.e
I
(Signs of Notary Public- State of orida)
f3`7S� o pGeC NotaryPbliic, StateiofFolrida
Commission No. �'4'E' S (Seal) Commissionp HH 737525
My comm. expires June 3, 2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21