HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i �
Bulldi_ng.Permit Application,
Planning and DevelopmentServices
Building and Code Regulation Division COI1rl1'I'lerCial Residen ial
2300 IrrginlaAvenue,Fort Pierce.FL 34982
Phone:(772)462-1553 Fax:(712)462-1578 .
I
PERMITAPPUCATION FOR- -
PROPOSED-INiPROVEMENT LOCATION:
Address: I
.Property Tax 1Q##:,11,II A 1Q-as"-ac,D:fa Lot No:., o?/
Site Plan name: ��Ji � �, � Block No.!Q---
Project Name:.. 44&&U►✓V. 0 _
DETAI LED=.DESCRIPTION-OF WORK:
f -- on -
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional workto be performed under this permit-check all that apply:
Mechanical —GasTank —Gas Piping,,. _,Shutters —Windows/Doors _Pond
Electric _Plumbing —Sprinklers Generator Roof Pitch.
Total.Sq.Ft of Construction: , Q Sq_Ft of First-Floor:
Cost of Construction:s lar, 6;, ,dy utilities Sewer Septic Building Height:
OWN,— Rf%-ESSEE: CONTRACTOR:
- a
Name Name:
01
Address:3/(o Company:
0" �
City: 1+ •State: Address. a
City,:�S�`o�,c_
Zip Cade:, �3� Fax: f-�p- 1 State:ir-G
i i
Phone Nod -<5 XC21� Zip Code:y���.�,� � Fax:
[ Mail:
Phone Nor 79a) .��Sleir�o ,91
Fill in fee simple Title Holder on next page{if different E-Mail b c,p Y_® o6e7.,?0-;4
from the Owner listed above) State or County License &_a—J -
If value of construction is 2500 or more,a.R1:CORDED 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 A plicabie MORTGAGE COMPANYc Not Applicable
Name .95-- Name:
Add r ss: ' Di Address:
L
City: �,� State- City: State:
Zip:_ 3g,�� Phone / /—.S"9� Zip: Phone:
FEE SIMPLE TITLEHOLDER: �Not Applicable BONDING COMPANY: KNot Applicable
Name: Name,
Address: Address:
Clt}+: City:
Zip: Phone: Zip: Prone-
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ana covenants_that may restrict or prohibit such
structure.Please consult with your Home Owners Associatiowand 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 con currency review:room additions,
accessory structures,swimming pools,fences,wails,slgns,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 posters on the Jobsite before the first inspection.if you intend to obtain fiinancing,consult
with lended Rr an attornev before commencing work or recordina vour Notice of Commencement.
AN
Signature Contra gent for Owner Sjgnat a Contractor nse Holder
STATE OF FLORID SPATE OF FLORIDA
COUNTY OF S�' Lt t COUNTY OF S `
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
W Physical Pr ante or Online Notarization et,'!"�'Ph sical Presence or Online Notarization
thls2!!`dayof 1
XCCWgX 20?� by this day of -1)Pe,_ N1 l3P .20`j by
,vr� N
Name of erson= ing statement. Name of person mal i T,statement.
Personally Known^ 2 OR Produced Identification Personally Known OR Produced Identification
Type`of identification Type of identification
Produced Produced
. CA4�al& WOO�CX
�o Sll1�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-state of Florida)
y► �qublrc State of Florida
Commission No. .,t�( 2aI No. I �,,, , `6Aerntt Woodard
apy'" `f� No ry PutNic State of FlotMMIS03n
± My Commission HH 039826
eunnte Merntt Woodard Ex ues 09/07/2024
K v My Comm
M10 xP 09/07W24
REVIEWS- FRONT S VEGETATION 'SEATURTLE MANGROVE
I COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Ev.