HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L,UY LL --�
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
DETAILED DESCRIPTION OF WORK:
:"/, - c\\k \b ' .s:. b c '1 nr 5
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 'A Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ $ 1) 47 S ^ Utilities: —Sewer _ Septic
Lot No. 5
Block No .�- 35-3
Building Height:
Pond
Pitch
OWNERAE5SEE:
CONTRACTOR:
Name":�Vk R
Name: 11WNw O S Ir15 _
Address: 112 `cn0ye A\ QV
Company: V i1R OQ.S hl-
City: �C �- Q ► Q,C C,Q, Stater
Zip Code: 3VOy5 Fax:
Phone No. 7) 10 V7 0 " 33) E-
Address: Sal 3 WN w PN V `h
C 1 Q.
City: R0 lr� 5t �.V G1 0- I State: _�_
Zip Code: 3 4 l A Fax
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail t%-e l dt'4 `QN M IAr l l'o
State or County License a 1 S? R
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.
DESIGNER/ENGINEER: ,L _ N t Applicable
Name: bvh 'S 0v 1
Address: A oo \M�637 A bh
City: Ti. \,(o W State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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.
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 lenrier nr an attornev before commencine work or recordine vour Notice of Commencement.
Signature of Contractor - or - Owner Builder asIpplicable
STATE OF FLORIDA o
L\)c t 4Z.
COUNTY OF S �-
`-
Sworn to (or affirmed) and subscribed before me of `t
Physical Presence or Online Notarization
this _S__ day of OQ.(.• 20 It by
�tlgh� NcslcI N $
Name of person making statement.
Personally Known ---A OR Produced Identification
Type of Identification Produced
1S��g
(Signature of Notary Public- State of Florida)
p
A
�
Notary Pub1c sate of Florida
Darlene C Wright
Commission No. (Seal)
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MyCommie6ionG4290092
Expires 0110912023
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Rev 10/12/21