HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 l L Permit Number:
C L ` L L C- - 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:
Property Tax ID #:
Site Plan Name:
Project Name: �� �'Y1
d
DETAILED DESCRIPTION OF WORK:
Lot No.(-P
Block No.
_/-Cc,r 07t4l shil)"./0 0" 6!4 v-K.
li l r o% Mo Jt ej- br A,mm ra r�% I i rA/I N ew 44 ki,tkeg
fix: �c orel
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
_ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Sprinklers _ Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ 314550 .y Q Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameTh5fp 5- N!Olt 17-AtL-Ul
Name: A2an C' M0121r5
Address: II ' FOIIT ��On OUOftfh4�
Company: P-e 5
Address I ple- '
City: f=f2rT hl-Pe State: F-L
Zip Code: 951 Fax:
Phone No. ('1-1Z DSO 1 53W E-
Mail:
City: EeriTt�, State:
Zip Code: 2>2J-) 2 Fax:
Phone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rY)q t ration ze
State or County License Izdri U
If value of construction is 25o0 or more, a Ktwrcuty fw11ce of a,umm=11a.=111=1„ � �y.,�� �..• I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: V Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 Ipnripr nr an attornev before commencing work or recording vour Notice of Commencement.
Signat of 0 r/ Le ontractor as Agent for Owner
ATE OF FLO DA
COUNTY OF et'Y 0 61- -
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 2 dayof Q<Cerytbeii 2011 by
Name of person making statement.
Personally Known OR Produced Identification_
Produced —Pt- bL-
Type of Id,-t(.�
! (-entiificatico�n
/ Upec W.67L44
(Signature of Notary Public- tat f Florida)
Commission No. i#1 1 Y7 q/1 (Seal) Notary Public State of Florida
Rodriguez
Adk Ricardo J
My Commission
HH 187911
IIII
Exp.10/17/2025
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/ZU/Z1