HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
110
' LL UIL
` 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 LOCATION:
Address: 485 �k I,Ls
Property Tax lD #: a`SS;L - 't5�ob -(Dos 166 d 06 ` Cp Lot No.
Site Plan Name: W ATti(z--,Q 6 Block No_
Project Name: t-t r- bu C C l
DETAILED DESCRIPTION OF WORK:
SC)cs G!7i i"\Wo (-kkYE—s
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 f Shutters _ Windows/Doors Pond
Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: ii Sq. Ft. of First Floor:
Cost of Construction. $ ` 0 -OUtilities: Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A)ACUO Kf oLt-ec
Name:
Address: 1A
Company: N,%AiQ k
City: 1,2 C State :V- _L
Zip Code: 34Gl Fax:
Phone No. E-
Address: (A10b SC P,L-YA2 C' P
City: �: AuLi-"a-+ State: L
Zip Code:?>4qc Fax:
Phone No C-f
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail QrAlA ' kn
State or County License
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:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Add ress:
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 molder 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 ER: Your failure to Record a Notice of Commencement may result in paying twice for
improve j en,
o your pro erty. A Notice of Commencement must be recorded in the public records of St.
Lucie CoUinty Ja po ted o thejobsite b ore the first inspection. If you intend to obtain financing, consult
with lend o at'llrnky 'iefore commehci►1.R work or recording your Notice of Commencement -
Signature of Ittractor - or - Owner udder as ap 9icable
STATE OF FLORIDA
COUNTY OF �M. PscX1 t�'3
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this La__ day of 2.)2 20Dk by
1 {Z.f -,E �L
Name of person making s atement_
Personally Known OR Produced Identification
Type of Identification Produced
A. S 7--0 /
(Signature of Notary - State of Florida)
XSSI
IER
G E 3
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NCO
Commission No. e
ti OGG 9086M
iydj plO. eondadi�s�®
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y� Ueda •' �� `��
0
REVIEWS
FRONT
ZONING
SUPERVISOR
1
4lffiETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
RLVILW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21