HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: Z3-.Z Permit Number: SL( d3g�J
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Building Pern it'Application
Planning and Development Services
Building and Code Regulation Division Commercial )0 Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: U- 5 k CFI, 40Lo rluG �-�-•
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Address: 3ZOS 31`+ S'liree:�c F7 6erc-L FL '3LL0146
Property Tax ID#: L1Iz 50 00SO - DOD 3 Lot No. 6
Site Plan Name: Irv-s+ _eJ C06P Block No.
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Project Name: Xy- >•�e=RA
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height: i
lONTRACTaR P
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Name '` -
lA n e� t'osc ' �' ' Na�me: IbScD to�
Address: 5� 6W � Iaen t [� �r'. Company: IoSCc` 1rlC
City: Foa.-r State"�:Z- 'Address: 3ZOB (ndvs��o,,� 3(� NYeee ` '
Zip Code: '!�PYR gq Fax: - City: R, Pl Q4« State: "AF-L
Phone No. 6fcf 248 5 3e l Zip Code: SQ GiLl(6 Fax: '717- IQ(go '310 3
E-Mail:_pl,rine( 0 JYv-S�eej •CoyA Phone No -1 "T Z 4GO 3l 01
Fill in fee simple Title Holder on next page(if different E-Mail AIVY103l�SCG`Co�l$�f�C, Od1.0
from the Owner listed above) State or County License CC'1c l 5 -zRN O
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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:_ _Not Applicable „
Name: R\Gcpr —" A'556c4w+-eS Name: ► MC-
Address: C--C Address: P0 am)o W3 n
City: State: P*L-- City: oSh's 0 State-KEIM
Zip: Phone7zz-3`ft-g32Z Zip: Phone:
FEE SIMPLE TITLE HOLDER: 7V, Not Applicable BONDING COMPANY: Not Applicable
Name: 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 avid 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 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 attorney before com mencirig work or recording our Notice of Commencement.
Signature of Cont or-Owner Builder as applicable
STATE OF FLORIDA „
COUNTY OF 5 = .4 c �C
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of FCe5V7.d;gJP— 2042/ by A goys cA
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida)
ottgY?�9G NEIL FRANK
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Commission No.' (Seal) Commission#HH05902 .
c� Expires December 3,2024
9�-oFF1.OQ Soured Ttaa Budget Notary Santa$
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