HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 12-1 Permit Number:
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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
PERMIT APPLICATION FOR- We&4—
PROPOSED IIVIPROVEMENTLOCATlOW
V
Address: 1 NL-TTA L MA 'ST, , 46' r-f-- 51-, L-0" ,e a F L-- -5LI'Y.S --�
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
ETAILED DESCRIPTION OF WORK
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric Pumbing _ Sprinklers _ Generator : Roof
Total Sq. Ft of Construction: � D F� Sq. Ft. of First Floor:
Cost of Construction: $ 2-02-6 O Utilities: —Sewer _Septic
— Pond
Pitch
Building Height:
QWN MESS
COI�iI'RACTOR< ._
Name ,,1 t7
Name: AIV
Address:_ 7 >�tl.T" (�/Z 'T
City: State: F-L
Zi p Code:34 4? Fax:
Phone No. 77 0 &- �2.4G5
E-Mail: �10(6
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company: E 1 e- flom be-4- 'tA,
Address: IS3'i SE� O&U-tfl %� r ;i ►'lac-( �'" c r
City: � sf State: F.,
Zip Code:3gg592 Fax:
Phone No'I-IcR-� -1-'?)72-2-
E-Mail MaC i �7zk _ i n ed+ke` himber. `
State or County license G�--c I L4 a V 4
IT value or construction is 75W 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:
Address:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 tw'ce for
improvements to your property. A Notice of Commencement must be recorded in the lic records of St.
Lucie County d posted on the jobsite before the first inspection. if yo Inte d to obt financing, consult
with�hIder of attol ey berme commencing work or recor; i you otich of Co encement.
re of Owner/ Lessee/ConJr9(6tor as Agent for Owner
Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA I
COUNTY OF i ino� ran COUNTY OF I l—�iC-Cle— �t
Sworn to (or affirmed) and subscribed before me of Swor}� to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization t/ P ysical Pres�ce or Online Notarization
1.
this day of <� fn 2024 by this f� day of KEC,� �i,L - 2020 by
t e C fir
Name of person making stat ment. Name of person making state ent.
Personally Known OR Produced Identification � Personally Known OR Produced Identification Y�
Type of entification Type of Identification
Prod ce Produced
REBECCA J. MILLGATE
REBECCAJ. I I
(S' atur y P ic- Sta a Commission p GG 2671 8� a e of o ic- ate _ "- Notary Pu61ic •State of
" OF ' Commi sion M GG 26
My Comm. Expires Oct 15, 022'
Commission o. / F•t`••' Comm. Expires Oct 1
mission No. • � •(Seayl'�
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