HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR
PROPOSED IMPROVEMENT LOCATION:
i-i-r-" U V•r * • a �GZ. - ��l CL-%-
Address: 2 - ' - .w, c'C•<A � ;�.C, . —
Property Tax ID #: GoZ) - vo o - c, Lot No, L c 7 -
Site Plan Name: W - \ \N' aim S
Project Name: L� , \ \ � S
DETAILED DESCRIPTION OF WORK:
Block No.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Electric _ Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ a.
OWNER/LESSEE:
Sq. Ft. of First Floor:
01_• . J0 Utilities: —Sewer —Septic Building Height:._
Name k W kkk'C .-, s
Address: 1 (0 Yl W ,, Hruyihh C i, s c LL
City: I?c_J \ v,r-, C k. A- ti State: P t-
Zip Code: 3y `i -► o Fax:
Phone No. Q -1 U - Cj S - c( 0 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: ;S ci.vy---R S f'5ryn
Company: Jwn (�ru._...r,
0.kC4 %,-_4 LGC
Address: !)3 Y Sic
City:
State: -V-L-
Zip Code: '3`t9S -1
FW. CAC-W. 77-20Ci--0- M
Phone No c QZA +f . Sl `°
E-Mail 1A 5's33 c0
State or County License
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:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: _ Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 an appllcabie 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 v.our Notice of Commencement.
Signaf5re of Conrrract+Tr - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF ry-\ r, 'rl
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this�Lday of�.ct��ry r 20 3-r by
s n
Name of person making statement.
Personally Known L/ OR Produced Identification �_
Type of Identification Produced f t w-, act-S F-Ir ,y-Lt- Lj u 1 Sew
c���
(Signature of Notary Public- State of Florida)
KAREN CODERRE
e43
Commission No.GG' TR1 60l (Seal) .: ., MY COMMISSION# GG 981001
air EXPIRES: April 23, 2024
a°Kp4° Bor dod Thru Nolory Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED