HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 11-29-21 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
1
Address: IOE (47 ?I Yy luizecI(J2 DIly-
PropertyTaxlD#: 232I - C)I- C)O1, - 000 Lot No.L5
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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 —Plumbing c, _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: y D bO . 0 O Sq. Ft.of First Floor: U136 0 .00
Cost of Construction:$ 5,SOG .00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Taf0 VCr-- Name: ?_ef4'(_eel cis(-()
Address: + 10 G L1 -7 1 VIC ILQ..Qd\X_ 0( Company: C(SCCJS RooFlvtr7 /�e 09 1' ffy
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City: T O f*- 3;)\-e '(CP State: Address: QCi t-) Sw 36 t r, 5 �-
Zip Code: 3`(G4s Fax: City: 2Gl1 01 C I �-`/ State:
Phone No. E- Zip Code: 3L4 Cl 91 7 Fax:
Mail: Phone No 11 L- '6Z'S- ICU-7 q'
Fill in fee simple Title Holder on next page (if different E-Mail C t5 Co 5 foo FlV\ i (e(Zi Iraq ybtc
from the Owner listed above) State or County License 9D1;LGl
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.
SUPPLEMENTAL CONSTRUCTION LIEN 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 Granting a permit will authorize the permit holder to build the subject structure
which conflicts with an 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 orraanjattorne b encin work or recordin our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA Q
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COUNTY OF I
Sworn to(or affirme j a d subscribed before me of Physical Presence or_Online Notarization
thi k1'day c M"( 20:ZL by
S-ef f Cisco
Name of person making s atement.
Personally Known X OR Produced Identification
Type�f dentification Produced
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(Signature of Notary
Ph ic-State off/Florida)
otWA NANCY
Commission No. r / 5' al) a� s% N Public
T
o' State of Florida
a Comm#HH167992
y CE%V ExPires8/23/2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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RECEIVED
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