HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
RU �" '� � �°' � � Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
X
Address: Z 1 1A Ooull✓ In i POr+ G+• LU CAC_ 34452
Property Tax ID #: ig i 1 - an - `0��0-I"!f "o60r a Lot No.�aa
Site Plan Name: �kA i>�oie= _ _ Block No. -1
T
Project Name:
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter
Second Electrical Meter
(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:
Cost of Construction: $ (aal iO0
Gas Piping
Sprinklers
_ Shutters
Generator
Windows/Doors _ Pond
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Roof Pitch
Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name o0-Viy N P-lonV1
Name: 61P_) UQ=i iXCA-)
Address: '2%'A Q'),X LCl
Company: C'' UCV-diQn 150AQV7
City: PDX \_ S)r- W42Ae Stater
Zip Code: SLAq �2 Fax:
Phone No. 77-7 2 - 919 '5S2(0 E-
Address: -he14 ai'1CAOte, 9-cl. (Anii- A
City: State: rL
Zip Code: Fax:
Phone No
Mail: (aC`�r jQWIi io (Q. U f� 1 oCO�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Gcl[�Irdia�.rGdAQt
State or County License 01C 51
if value of construction is 2500 or more, a REcvRDW Notice of commencement is requires. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
.V
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF11�1�ikC:d`J
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _L_ day of tDeMM)Dex 20Z11 by
i
Name of person making statement.
Personally Known S OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
apuk,,
Commission No. (Seal )
EMILYY SOTO
Commission #002415703
*
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Expires August 6,2022
p,00
Bonded1WBudget Notary SWAM
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Rev 10/12/21