HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
"OLo-), zl., � `*Y` Building PP Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
23W Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: J HIq t Q1 - 0 tC0i_o -OC>Q `°7
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION.OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
V
Lot No. Y,
Block No. I r7
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: $ 142, (.)C)f> . o b Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name d `4 L iS o�_ -e ssS i' "N. 1
Add ress: L4
City: .Slot Due, h � _ - State: I� �
Zip Code: 8 q Fax:
Phone No. C� S � �.ti'7� • q3,Tl
E-Mail: i tt S51`�? t? , C �i • VDm
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR: —
i Name: T� S 0_r: C.
Company: iX-n M-2.F e ' S € 1 i. -4-,
Address _Q00NCLCy RCS '_Q_.1
City: A - Pi f' f'� �_ _ State:�
Zip Code: Ql4K-w Fax: 1-7;:Nu LA 7 0,
Phone No— D 1 k_0 bq D
E-Mai!`=��1"i� a��'�14!• 3'�Gi �t't±'C;��S ["u f.t�c?l
State or County License ! - C.
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,5W or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:[ _1'iC i 1' — C- Q'i1_PQ_rf n ,r, Name:
Address: � (AV-e- Address:
City: State City: State: _
Zip' Phone . a 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 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 and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 1 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, wails, 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 commencint, work or recording your Notice of Commencement.
Ak
Signature of wne essee/Contractor as Agent for Owner
STATE OF FLORIDA tJ-T
COUNTY OF SO c'
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this 75 0 day of Jy Y) P_ 202_� by
Name o person erson making statement.
Personally Known OR Produced Identification
Type of Identification Produced IQiC,30-TANVI SHAH
NOTARY PUBLIC
(Signature of Notary Puglic-"5tate of FlerWa
NZT
Commission No. "50 0 2 6 g A(Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
i DATE
COMPLETED
Rev 5/ZO721
ID # 50026961
MY COMMISSION EXPIRES NOV. 12, 2025
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW