HomeMy WebLinkAboutBuilding permit app, updated with new contractorAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �j7ln.�
Date: 1 Z- (5- Z I Permit Number: �I l L- " I
4V0 L SQL H
0�-
P o ' 0 VL 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: I
Address: 4KL I J'
Property Tax ID #:
Site Plan Name:
Project Name:
S-P I Y- o d b
=L
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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 :Z Roof J Pitch
Total Sq. Ft of Construction:-1`'L00 Sq. Ft. of First Floor: _7'400
1
Cost of Construction: $ 10 i OUy Utilities: -Sewer _Septic Building Height: 15
OWNER/LESSEE:
CONTRACTOR:
Name Cs:j 1-Ni V1, 4 l O.Y C \CA
Name:
Address: V QCK 5 O-V1
Company: i C.-
City: r j �2f C2 State: fL
Zip Code:2iAC( LL'"_ Fax:
Phone No. E-
Address:
City: P41 rh CcT J State: Aa.
Zip Code: -3L( qo Fax:
Phone N / cf 0
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rU 0+J
0 W If- L (_.0 • G
State or County License 131 7.3S9
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 Vntin a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Associagtion 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 commenrina wnrk nr rprnrriina vni it Nn+ira of rnm manrarnan+
-Srgina ,,We of Cbmtractikir - or - Owner Builder as applicable
STATE OFFLORIDA 1 LctC
COUNTYOF
Sworn tojoraffirmed and subscribed before me of
"Say
Physical Presence or _Online Notarization
this 6j of C b-Rr 20� by
Name of person making statement.
Personally Known -:?—( OR Produced Identification
Produced
:MaA_
.tion
nature of Not1a Iic-- Stta`t/eI of Flor a)
�CY �ERHORST
l+� 1`'li�
Commission No. (eal)
Notary Public
g State of Florida
? ComnpY HH167992
Expires 8/23/2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10112121