HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE APCeCrEPT EDit mber:
Date: l2' �(O' �l
Ll� �UI ...� r
,,'..-.. L� - Building Permit Application
Planning and Development Services Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding _
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
� p�Ess s� asp 3ygsz.
Address: -7%I y1q oe
Property Tax ID 4: 5-
Site Plan Name:
vDi2E`f
Project Name:
A2Esi't�E�G�
FDETAILEDDESCRIPTION OF WORK:
i � fZCO F s K S� M
'FER.OFF EXiST� N
S T 0/ iT H
NiN TO Pl'' vJOOb
__ ---- — Second Electrical Meter (Affidavit required)
New Electrical Meter
CONSTRUCTION INFORMATION:
Lot No. ---
Block No.
AN 8 12-F PI-►�C.�
Additional work to be performed under this permit — check all that apply: Windows/Doors Pond I
Gas Piping _Shutters ._
Mechanical —Gas Tank — i� Roof _ _ ____—Pitch
Sprinklers Generator
Electric _Plumbing .— —
— Z 3 Sq. Ft, of First Floor:
Total Sq. Ft of Construction: Cost of Construction: Building Height:
Utilities: _Sewer —Septic $ __-1--------------
CONTRACTOR:
OWNER/LESSEE: 6V,`
SI-{�2c.PrAi� Name:
Name Av0RAF Y Company: CAM (2p�1-1f�11�
-1 G P2ESS sT `xiE
Address: lb1=-L Address: 3g`'Ig S� P+
QO(2-T ST LVC� E State: — State: _L-
City: city: 6 w A21r
Zip Code: 3yq 5 2 Fax: D'1 E- Zip Code: 3yGQ1 _Fax:
Phone No. 9 E;L4 -- '20`� - 11
Phone No
Mail: rYtY0OY1
E-Mail i f1FD
Fill in fee simple Title Holder on next page (if different State l County License rLID 9Zi DA _
from the Owner listed above)
tice of Commenceent is
If value of construct? rOo or more, a more, a RECORDED RNoticetioof commencement is required. rred.
If value of HAVC is $ ,500 o
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: Y Not Applicable
DESIGNER/ENGINEER: ____
Not Applicable
Name:
Address: State:
City:
Zip: -- Phone
FEE SIMPLE TITLE HOLDER: ____
Not Applicable
Name:
Address:
City:
MORTGAGE COMPAN .
Name:
Address: State:
City:
Zip: _ _______— Phone:
BONDING COMPANY: ____ Not Applicable
Name:
Address:
City:
Zip: ____ —Phone:
Zip: ___-__--- Phone.
obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to
I certify that no work or installation has commenced prior to the t will authorissuance of a ze he permit holder to build the subject structure
St. Lucie County makes no representation that is granting a p
applicable Homeowners ASSOC! ion
rules, bylaws or and covenants that may restrict or prohibit such
which conflicts with su erform the work
structure. Please consullt with your Homeowners A permit, do hereby agree that I will, for
all respectonp which may apply.
In consideration of the granting of this requested p
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 noult in
r{W1Ce foruse
a Notice of Cornmencement public records of St.
res
WARNING TO OWNER: Your failure to NotidCe of Commencement must be recorded tin the p financing, consult
improv nts to yo p Y
Lucie ounty and posted o e jobsite before the first inspection. I you
wit ender or an attorne b ore commencin work or recordin our Notice of Commencement.
Signature of tractor - or - Owner uilder as applicable
STATE OF FLORIDA----
COUNTY OF
x Physical Presence or Online Notarization
Sworn to (or affirme )and subscribed 20ef�or-ebYe of ____
this 1 � day of �' 6✓i �II.VWdJ SGNMa� .
Nam of person making statement. x
Personally Known
OR Produced Identification
Type of Identification Produced -----
(Signature otary Public- State �f Florida)
554P9 - (Seal)
Commission No.
REVIEWS FRONTTRREVI�EW
NG
COUNTER
RECEIVED
COMPLETED
Notary PubYo State of Florida
Maria Y Caiachagua
My Commission GG 935568
Ex re
1210112023
O/ M1
EGE
SUPERVISOR
REVIEW LANSV REVIEWON
SEATURTLE I MRAE GEROVE
REVIEW