HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12" (S ` Z� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: F3Z3
Ce
So
ns� i pi ra C -r c,lc
Property Tax ID #:
342
-1 O 30 o 7-3 OUO • Z Lot No.
Site Plan Name: Block No.
Project Name: Q D KS V o W
DETAILED DESCRIPTION OF WORK:
lr%%AuII r�W (gI2- 4e r Z2D✓ C_frc. it Vol br-C . &4- b "-4'4- .
rk w Pr I c k *-vl s l sa•.--
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical
)a Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
_ Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
_ Pond
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Ika. (Zo L-Sv ol�l
Name: 1kk c,l,kc cA PrioLe
Address: 19ZBb
Company: Pn lQ 1✓Lcc%,'ccI
5Lr cas of Pt
City: PSL. Stater
Zip Code: 346IS2 Fax:
Phone No. E-
Address: 843 S lc,I=E,3
tk,.
City: F-P
Zip Code: 3L-H 4 S
Phone No -7"]2 • 3-Jo
State:
Fax:
6894
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail r^� re' Coe rn do - c lcc h c� ( co
State or County License EC 1300 - S$ S,
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is S7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 p rty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and post on he jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an att ne b fore commencing work or recording our Notice of Commencement.
AZ?1Q;i
SlifhatuFe of Contractor L4 - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Z5k - Lu�tL-2
Sworn to (or a ed) and subscribed before me of
't< Physical Presence or _ Online Notarization
this _day of 20zL_\by
i`l1 I&Nu_,Q0
Name of person making statement.
Personally Known _ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- Stat o Flor da)
p���, �\1
Commission No. (Seal)
v�, KAREND'DNOFRIO
MY COMMISSION A GG 237558
z,a`; EXPIRES: Augusl5, 2022
`:`;�°��``Bonded Tlw Nolary Pudic Underndters
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Rev 10/UM