HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LL! t UL
E� -` 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 LO ATION:
Address: S�
Property Tax ID #: \C' g -c>C3
Site Plan Name: _ ���_,-`��'�
Project Name: (_C Jb Ac
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
% <. 7 % %A
�3v.S`+0 \ � `•%t? C � L-�'Li�� , �� �J ti yi.�` .� � Ins. �.A��- i
P�-r'ar
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: oZ c� ® Sq. Ft. of First Floor:
Cost of Construction: $ tS �Z G� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name � N �- �A�
Name: nrlo"") -t s
Address: 1 f !�pi(_�E&SL4 ,7-cP,
Company: F r,-; Y+vz i A;,r-,AJU-
City: 2 � State: rL-
, 0 R S'T �,.0 G rfL
Zip Code: 3'(9 bZ Fax:
Phone No. "�'( ,Z `� 7 J E-
Address: rill Sk �2_r "r
City: Ao-�_I- �;- tvcti✓
Zip Code: ?qJ Fax:
Phone No '112-- koZie, • f2-&0
State:
Mail: 't_-G 2(2, 6T-T
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 4r.0H rnk W 4 vc',J k0O, c-`, & _
State or County License C&C / 33
If value of construction is 2500 or more, a KtcUKutu Nonce or commencement is requwreu. I
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:
BONDING COMPANY: Not Applicable
Name:
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. A Notice of Commencement must be recorded in the public records of St.
Lucid C-ellinty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with Ier/der or an attornev before commencing work or recording your Notice of Commencement.
`1.
Sign ure caner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA rr '
COUNTY OF d� /6,t
�C
ZPhysical
Sworn o (or affirm e ) and subscribed before me of
this day of 29,2-( by
Presence or Online Notarization
Name of person making statement.
+••'•„�����«"
B�Q(J�i
Personally Known OR Produced I entification
Lf
����
Type of Identification Produced -C /y l (
;: �+v� QSA� j% . Q •..
My Gamm. ExpireS
of Notary Public- State of Florida)
(Signature Y
i _G 354733
GG 359733
Commission No. �� (Seal)
•••••, S� • A �G'� O�:�r
OF F .
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21