HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Residential
Commercial
CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ► a. 3 Ec" C-(-'eek L n,n-e..
Property Tax ID#: `ASOq —S: L-� �C'1-4 Lot No.�_
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
y1312.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
—Electric -, i mbing _ Sprinklers _ Generator ✓ Roof Pitch
Total Sq. Ft of Construction: & 3c�zl Sq. Ft. of First Floor:
Cost of Construction: $ a►s`i,1CC> Utilities: _Sewer ✓peptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
N a m e Av A-, ..., (-4oJ c-
Name: "S4•r, A, !Lry%:,- -- _
Address: �a l A.)z Al2' S%z
Company: G-ys�c-- G,-+ � -S
City: State: FL
Zip Code: Fax:
Phone No. E-
Address: PS'- M% 1
City: 'PS L State: F-L
Zip Code: 34"K-00 Fax:
Phone No -1 17
Mail: 0.Jb,-"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 'z� !!�wrz-a-�' L&CS' C_W—
State or County License GCS IS a y73
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requireu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: [�,:.s�e��.r D.c,rS Name:
Address: Pca Address:
City: ►_1>.rN.�or-� State: City: State:
Zip: 3429 f Phone W 44f -c -QKA35 Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
BONDING COMPANY:
Name: _
Address:
City:
Zip: Phone:
. lot Applicable
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 granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with 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 attorney before commencing work or recordine vour Notice of Commencement
41 �44
Sign re of Owner/ Less / ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S1,A_,C e,
Sworn to (or affirmed) and subscribed before me of �sical Presence or Online Notarization
this- day of bc_k- r , 20 2 Il by
7z�� A �,�.� � &"
Name of person making statement.
Personally Known t,—' OR Produced Identification
Type of Identification Produced
(Signature of NotaH Public- St6ree of Florida)
Commission No. I'I1� a $ ZC4(Seal) tt� Kelly FPu�blic
Nota ry
aics
State of Florida
y ^L Comm# HH082506
s�N
Expires 1/19/2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21