HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0I3o�2_� Permit Number:
llo LI�C�Ur-
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: so�od
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 14(o— SD3 - MOLL[ -1 DOD -1 Lot No. 2(0
Site Plan Name: Block No. C
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
(Affidavit required)
f CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
XElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $,331
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
1
Name n 4k
Name: LA.A4.v\ 1
Address:
Company:
City:te: _EL
Zip Code: ?34(11el Fax:
Phone No. 4 - 9 L, AL E-
Address:
City: State: (_�tl
Zip Code: o1Z Fax:
Phone No
Mail: -i-
Fill in fee simple Ti a Holder on next Oa e (if different
from the Owner listed above)
E-Mail %
. (J
State or County License
IT Value oT construction is lbuu or more, a RLCURDLD 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 regpested 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 commencing work or recording vour Notice of Commencement.
lgnature of contractor - or - Owner Builder as applicable
STATE OF FLO DA
COUNTY OF 4500
Sworn tq (or affir ed) and subscribed before me of �O Physical Presence or Online Notarization
this Iday of Gi 20_)_Jby
LU(lurtd.)l A w-bh
Name of person making statement.
Personally Known 74 OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. 23 (Jeal)
sw�.vuvw�.+w
car Pp, Notary Futlic State of Florida
: Erica A Helms
My Commission GG 232657
Expires06'26/2022.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21