HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
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17 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: vl � �(I�l�rSh .�.�.�
Lot No. o� --
Property Tax ID #:
Block No.
Site Plan Name:
Project Name:\' i.
DEl'All_ED DESCRIRTION OF WORK:
tVLrr
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical J Gas Tank „Gas Piping — Shutters Windows/Doors Pond
Electric
K Plumbing _ Sprinklers Generator Roof — Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ O Utilities: `Sewer _Septic
Building Height:
OWNER/LESSEE:
Name i ��� CLvI `V
Address:_ itko 5 h r?r•
City: � f tC+`� _ State:
Ft Zip Code: t Fax: - I = 2
Phone No. `
E-Mail: vin++S k r.
trill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Na
Company:
Address: 04U i- I( klckl
City: State:�L Zip Code Fax:
Phone No I- (2 t-
E-M4 Fervv%#
State or County Lice
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: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
7L
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of tontractor - or - Owner Builder s applicable
STATE OF FLORIDA ,, -- II�
Sf e
COUNTY OF L�
Sworn t (or affirmed) and subscribed before me of ;� Physical Presence or Online Notarization
± this `7 day of 26LA IWZ , ZO,L by
tvl t.t�1 �4Ctri'a 1 'w
Name of person making stateme .
Identification's
Personally Known OR Produced
Type of Identification PProduced__da_�Le.T-� i L'6Q-r, Q
axLi %G Cr
(Sig ature f o P b 'c t of Florida)
i`r........ JULIE JANE MCCAVLEY
Commissio Nata p t� Norida
�, Commission NN 49824
F,arti My Comm. Expires Oct f, 2024
"
Bonded through Nationai Notary Assn.
REVIEWS
FRONT
COUNTER
ZONING SUPERVISOR
REVIEW REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW T
DA
RECEIVED
DATE
COMPLETED _--�---- vL -- -- -
Rev 10/12/21