HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: RR Permit Number:
° L 16� `�, L D 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: A 3 Lp P(I-r i l Q n-N -ell ' [+ --
PropertyTax ID #: l t4-7 Q1 - 0 iU -% Lot No.
Site Plan Name: Block No. l
Project Name:
DETAILED DESCRIPTION OF WORK: _ -
r' acC e CiciCe- (rQS �t bcai I i
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: $ I % WC) . p0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NamefbAA14L is o.. -4 t�1'Ve Name: b s ( x-C-
Address: LI -SCJ< T)r Cil�2x- Company: i1 i1ry S i
City: IA 0136-31- n r' h State: Address: O IV CLU) Rd '*Q ,
Zip Cade: 0_8 44 Fax: City: F1 Stater -
Phone No.�C3ci �'la 1 _ Zip Code: � 1� Fax: -7D. 41 pLj°-7U-71?
E-Mail:PC1i 4e "'Sjn '' a> li A hbO . (l pfyl Phone No-7���' 4UL4. � Oq D
i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) State or County License�{�' t t C
If vaiue 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.
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3PPL f T C� `7 CT ON L�1=1��L�1Al 1 3f#MA -t N-
DESIGNEVENGI TER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name• t-t 1 ' T►�-P
Name:_
Address: C
4 TE
Address:
City: r-C State
City: -State:
Zip: Phone �1-1 L� I l e
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: _
City
Address:
City
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 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 commencin, work or recording; your Notice of Commencement.
Signature VoC1 Lessee .ontractor as Agent for owner
STATE OF F N�T
COUNTY OF , I Qj
Sworn to (or affirmed) and subscribed before me of </ Physical Presence or online Notarization
this`? Q day of J V)n e , 2021 by
I v 1
Name of person making statement.
Personally Known OR Prod ced Identification a✓
Type of identification Produced__ D ?_ 0-) i* Titan
1�
(Signature of Notary Public- State of Aida )
Commission Now 0® GM I (seal}
DAREVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
TE
RECEIVED
DATE
COMPLETED
TANVI SHAH
NOTARY PUBLIC
ID # 50026961
MY COMMISSION EXPIRES NOV. 12, 2025
PLANS VEGETATION SEATURTLE MANGROVE
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