HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �% L•I Permit Number:
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o
`;"�` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial x Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Jti\.0 G ¢ vrl t`rJ
PROPOSED IMPROVEMENT LOCATION:
Address: y
9 0(�_> /v a }I✓� � /Ciu2
Property Tax ID #: N oil `_� l0 ` DO L 9 - 700 Lot No.
Site Plan Name: Block No,
Project Name:
DETAILED DESCRIPTION OF WORK:
10u
ft iS Piz) i { s ci U..�c4v 'Sow- e_ IOu w�P
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 _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ rS Qv� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name .JCvNvx LJ L
Name: P�t •I-e 6.e+1 5
Company' c%�O \Lv' 10'.4
Address: 4`-('0D !J YVW�
110
_
Address: 036 00 1, #LnLy it /94��
City: A-4 Pl Q-,r-L _ _ State: F�
Zip Code: n �l y Fax:
Phone No. E-
City: Jo,+,O AX-OC& State: i2L
Zip Code: 3 (PC) Fax: �77X Sle'Z-53t/O
Phone No 7 SLQ Z Z 10 3
Mail:
E-Mail 0tyivoit 4r ltv k✓ ac- Ogtwol s 401t,
FIII in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License V.//4:� 11)
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:
Zip: Phone
City: State:
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 reppresentation 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 ice of Commencement must be recorded in the public records of St.
Lucie County and post d on the jo Ite efore the first inspection. If you intend to obtain financing, consult
with lender or at m ncin work or recordin our Notice of Commencement,
Signatur Owner/ Lessee/Contracto sAgejjLVr Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this "day of NbO 20A by
I v lYV-�- ��t �•�JE't,�
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Com6isl n No. rTN 3 0'4 (Seal) �+h jF,�t;IFERGINhD01ARESCRIShME
(`�') My COMMISSION 0 HH7174
eXPIR1:S: May 25, 2024
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