HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: u,i i� ZT Permit Number:
P4 WC019 ,
V D' ` h' Building Permit Application
Planning and Development Services y
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:
Address: _bLQ -) /o
Property Tax ID #: 141 L4 - (010 - co c) 3 - 000 Lot No.
Site Plan Name: A- ULLa "t fCF J i. Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
,L\
Cylechanical
_Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_
_Sprinklers
(Affidavit required)
_Shutters
_Windows/Doors _Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C e( ixrh'5
Name: ko, L
Address: W IAA ✓-3 1:1- KeD3
Company: Up, W-
AwtNe ID,NAL4-tbr1.
City: 1-4 oay( rc�L State: PL
Zip Code: ?A 9 d DI Fax:
Phone No. E-
Address: t9 3 G Cow
wu, e-
A%A.
City: \'NeXJ LQPi
Zip Code: 3 14 Le c?
Phone No -�) 1 P.
Qt�
Fax: 77
Z - 2LW 3
State: � L
" S3 Ali
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail kit n AAA.- V
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State or County License CAC. nS I
a SC -a..
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: 1< Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: �C 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 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, otce of Commencement must be recorded in the public records of St.
Lucie County and gosted on the 'ob ite before the first inspection. If you intend to obtain financing, consult
with lend r r a ttorne re co mencin work or recordin our Notice of Commencement.
Signature of Contractor - or - Owner wilder a applicable
STATE OF FLORIDA
COUNTY OF _'l3� 2��✓
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 2 day of 00, 2021 by
NA0,% .Af ((/VQ�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificatio Produced
(Signatur of otary Public- State of Florida)
Commission No. 4 H 31 Z L/ (Seal) /% 1ERt11FERGMADINORESCRISANIE
I �' y )� MY COMMISSION N Hn3174
-M1� EXPIRES: MeY 25, 2024
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Rev 10/12/21