HomeMy WebLinkAboutREVISED BUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
9V LUC 'd L
Planning and Development Services
Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR: bP_Vz
PROPOSED IMPROVEMENT LOCATION:
Residential X
Address: r`k-j•2_
Property Tax ID #: 3`� 15 -'1 u Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter x Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping
Y Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: `4 131 O
_ Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor: Ll 1 31
Cost of Construction: $ to i ono Utilities: —Sewer � Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name y' - Col CASg,eo\r
Name: A. C,v
",,
Address: _-j Q1 �c��`avtc(lS ��
Company: �'7v'�2c� (
,; lc�rS c-,
City: Sk, Luca ¢_ State:-
Zip Code: 3` 1°is a Fax:
Phone No. ) - E-
Address: Skl
r=►
6ujI _ -
City: NA Sk.1,. act �
Zip Code:
Phone No —11L, �J3�9-
State: L
Fax:
_71oCj3
Mail: pow\o..oz:, jaaga %l .0 owe
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �_')
o- 1 d e(- . ( oi-
State or County icense
C_&C- I s au�i3�l
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. __�o Not Applicable
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: —
Zip:
Phone:
4Not Applicable
State:
Applicable
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 lender or an attornev before commencina work or recording our Notice of Commencement.
I ":��
4Z 125�L
Signat re of Owner/ Lessee/C nt ctor as A t for Owner
STATE OF FLORID
COUNTY OF •L xc:tX-
Sworn to (or affirmed) and subscribed before me of
—V"Physical Presence or Online Notarization
this Zj day of _, 2021 by
Name of person making statement.
Personally Known,Z OR Produced Identification
Type of Identification Produced
(Signature of N ar ublic- State o lorida)
—.—NY Finley
Notary Public
Commission No. H H b$n1 SDL' (Seal)
Q
a 'State of Florida
' ' = Comm# HHOS2506
s4CE Ipsi F-xplres 1/19/2025
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21