HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: iN _a 1T-aA Permit Number:
L O4W-L"' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982 CT"
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Vz-V o2
PROPOSED IMPROVEMENT LOCATION:
kddress: -:::�Sbl 15 . �c�QT�.4 12,1AQV
Property Tax ID #:yi c� �- k&0 1-MY0 - o0c) -- �e Lot No. 3 ��
Site Plan Name: Block No. O'�>
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter_ Second Electrical Meter Q (Affidavit required)
CONSTRUCTION INFORMATION:
i
Additional work to be performed under this permit -check all that apply:�--
Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: c;)- 0
Cost of Construction: $ lz� (Do —
Gas Piping
_ Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESS E:
CONTRACTOR:
Name
Name: J \
"'J%32 .,
Address: SSOL SL.y-A! d I?
Company:8�p nA
(Z0�(�
City: CL'r �5?t E-;2- State: L
Zip Code: Z Fax: --
Phone No. 7?a - % S `t"'t E-
Address: SSZ't
City:�Pot2T r���2��_ State: (::--L__
Zip Code: 2: R Z Fax:
Phone No -27,1 - .��,3- O kt V
Mail: -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
` _ o<v)
State or County License
_
k r]3 D Tha
it value or construction Is G.SVu or more, a KtLUKutu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: „ 1
1"
_ 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:
lot 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 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 recordinia vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as
applicable
STATE OF FLORIDA
COUNTY OF 51- LU-c1 C
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this' -lay of �JGU.Pwt6.-Q, , 20J( by
�uCAl'4 u C 11 tiS �;� Cl\A'�
III C( �c) W
Navi4e of person making statement.
in
Personally Known / ' OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- St/ate of Florida)
Commission No.G� O� 1 6 3 6 (Seal)
State of Florida
ordsion
GG 221636f2022
REEI
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21