HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12- / - /ZO
Permit Number:
° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential l/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: (Ze' I200F
PROPOSED IMPROVEMENT LOCATION:
Address: 1 N N 6 L1 ds fa Flores Ave. Forte 1�; erCe F �3 H 95 /
Property Tax ID#: 13b(o -50/ - Qy`6-?- ODO -'-;k Lot No. 2-
Site Plan Name: �O-�c�r GZa A/1/1 5-le h1/75 Block No. 3 0
Project Name:
DETAILED DESCRIPTION OF WORK:
/ZGMDI/e CX,5-31r.n9 Sknale rooF down tt �x&l a4id sk:r c
ti laVgW 1, -fail r, d e vPn 1. �nsfa.li MG4a.( 2cc asso r a P,, o-nd
ns'-fa if rne�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: 2506
_ Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof .3 // 2- Pitch
Cost of Construction: $ /5 1 Z 00 - QCo Utilities: _ Sewer _Septic Building Height: / O r
OWNER/LESSEE: '
CONTRACTOR:
Name 7aAr�c�a i4n►t 5-} Vh e,'05
Name: 17U 1 CG QY!/
Address: /Y'/h i/ 15 (a Fla reS UP
Company: -NM" -The MC+nI knnP [:,�
,Q
City: 'env--k- -?0. er-� State: FJ.-
Zip Code: 3N 451 Fax: 411 A
Phone No. 1111A E-
Address: 31'(o 5E [klQQ/er 5-6.
City: 5}U0.r *- State: V=L
Zip Code: 34(46k Fax:
Phone No 44Z—S':5iLZ--2-03C
Mail: 'z1114
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail /YXi�ifS�ilhGrrtGka 1��� Lt �f//5. nP 6
State or County License C-C C 133Z 3qb
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.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not
Name:
Address:
City:
Zip: Phone: n
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has c(
MORTGAGE COMPANY: _ Not Applicable
COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
is he by made to obtain a permit to do the work and installation as indicated.
the issuance of a permit.
St. Lucie County makes no representation that granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homew Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeoi 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 po on the jobsite before the first inspection. If you intend to obtain financing, consult
with Ipndpr nr an nrnpv hafnra rnmmanrina wnrlr nr rarnrAina vn„r runfira of r',,..,.., e..�a......"f
Signat P Predmractor- or - Owner Builder as applicable
ST E OF FLORIDA
COUNTY OF 1941m 6e-4_c_h
Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization
thisy M day of ])r=,-9W18G2. 2021 by
Name of person making statement.
Personally Known _*><— OR Produced Identification
Type of I ti Produced
(Signature of 1191ary Public- Statefof Florida.�y
TNVa"Y
PuCI¢ StM of Flq.deCommission No. - 21IO(o 2 (Seal) Nana A Molina
tAy.^,ommla-w 3u 211062.
F:.pifs5 C-:n6:2C22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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