HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�)V" LULU f
- �.
°�4011�t
i.
o� Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: � LA C)�pD I Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
�- o—
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: 1oj Sq. Ft. of First Floor: 758 S I;t
Cost of Construction: $ LA 6 1 . S S 8' Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name \jY, poi or k aA_3 A1.•e_ Name: rvbA."-
Address: ;Lo _e% 5 P&,r- Dn Company: Q &;(brr
City: PSG- State: rt" Address: Sit SL'� ESL (jtc1k
Zip Code: '6 1qbt� Fax: City: P S �.- StatS
Phone No. c� 3�1" 5kn-`A iC`,D E- Zip Code: _,4!�- qS3 Fax:
Mail: 1o1e,A,, a-? 6-_> Phone No 'l'IZ- -7tn53
Fill in fee simple Title Holder on next page (if different E-Mail �° ODD ( C from the Owner listed above) State or County License GG-r✓ (5 ��Z 3`(
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 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: tar 4� Per �d e✓�
Address: y %-1 9,0 A-e
City: Sor State: F L.
Zip: _3 A%p__ Phone
FEE SIMPLE TITLE HOLDER: ---Not Applicable
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY:
Name: _
Address:
City:
Zip:
Phone:
--Not Applicable
State:
BONDING COMPANY: P--Uot 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 Ipndpr nr an attnrnev before commencine work or recording vour Notice of Commencement.
Signzoure of Contractor - or O ner Builde
s applicable
STATE OF FLORIDA
COUNTYOF �e—
Sworn to (or affirmed) and subscribed before
me of --Physical Presence or Online Notarization
this It clay of 2021
by
Name of person making statement.
Personally Known --- OR Produced Identification
Type of Identification Produced
��z9S1�
(Signature of tary Public- State of Florida)
ZpR AS K®Ity ney
sO�
Q Notary Public
Commission No.OlAD$a50Q (Seal)
'r—State of Florida
y 2 Comm# HHOS2506
SINCE is Expires 1/19/2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE ----
-
----
----- —
RECEIVED
DATE
_
COMPLETED
Rev 10/12/21