HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IpQ.
Permit Number:" '0 U
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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: Q S Q g L-cr\-Qs
I PROPOSED IMPROVEMENT LOCATION:
Address: 1 fO W
Property Tax ID #: - 0 0 �-- 000 - 1-I
Lot No.
T
Site Plan Name:?Ot) dl)- 0..LL Q_ ,'E"'-�`>ir'jQ, I pis w. No.
-Block
L
Project Name: � _[ C)
DETAILED DESCRIPTION OF WORK:
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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: $ . o Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name r
o
Name
V
Address: LVAM WULT04U
Company4d'e
City: 0f+� L•cu _ State: _
Address:
Zip Code: 53 Fax:
City: A State:
Q
Phone No. �a' LO�" p� E-
Zip Code: Fax:
Phone No Ur 7�51
Mail:
Fill in fee simple Title Holder on next page (if different
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E-Mail i OLYNl60 21 Y)t OV14CI . COrYi
State or County License Le 55
from the Owner listed above)
If value 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip:._ Phone:
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
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.
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 lender or an attorney before commencing work or recording your Notice of Commencement.
1'�" 'rij 0 � M:S� —
�.
ture of Con ctor - or - Owner Builder as applicable
STATE OF FL IDA
COi2f Ch owl
Sworn to (or affi ed) and ubscr'bed before me of Physical Presence or Online Notarization
this _,� day oflztv20_%by
Name of person making statement.
Personally Known X OR Produced Identification
TVa,e of Identification Produced
(Signature otj N4ary Public- State of Florida)
Commission No. 4Jk+ 3101 { (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev�=
MARY BROWN
20`' ,' Notary Public -State of Florii
*; Commission # HH 37071
9e My Commission Expires
t� � August H, 2024
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW