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 `w'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: tir, f �
Q� SfD,IMPROVE MENT LOCATION:
Address: `t� 1_1JL ke V i SfQ ) Y71J ��i�%J n (+
Property Tax ID #: V2'-i7'_-6D0-0 o t -ono ' ( Lot No.
Site Plan Name: Block No.
Project Name: ppddff
t 1" I DESCRIPTION OF bRK:
- V• 115 S_Lm F(5 u
New Electrical Meter Second Electrical Meter
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Addiinal work to be performed under this permit- check all that apply:
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_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors —
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ 5, 0 T yro Utilities: _'Sewer _' Septic Building Height:
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CONTRACTOR.
:a�Y
Named
Name:
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Address: I (N�
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Company: "'Many) I"filr( 0oC(t 1 ("
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City, State: ry
Address: `�.(J s C(
City: State,
Zip Code: �Jr Fax771'3gg::! 7?7%
Phone No. % 7Z
Zip Code: 5 Fax:-7-
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E-Mail: ro<� 6?f?CtC-�YYI C �, 1'1��
Phone No� Z- 72�
Fill in fee simple Title Holder on next page ( if different
E-Mail OSStN►ahi�t Cf.'�')'iC�1S ���
State or County License M
from the Owner listed above)
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.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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.
Sig f Owri&rt Lessee/Contractor as Agent for Owner
* na uj' 'Contr►'ac or/License Holder
am.
STATE OF FLORIDA,;:Z�J
COUNTY OF hIC1'L'
STATE OF FLORIDA-4
COUNTY OF
Sn to (or affirmed) and subscribed before me of
7Physical Presence or Online Notarization
this day of , 2020 by
S5wwn
Sw to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of `/ 12020 by
�J:C4 Qc Y •
Name of person nYaking statement.
Name of person akingstatement.
Personally Known OR Produced Identification
Type of Identification
Produced
Personally Known V/OR Produced Identification
Type of Identification
Produced
, Q om' —
(Signature of Notary Publi
Notary PubW State of Flo► ft
iOr
Crap A,Groasman
Commission No. My lesion GG 983089
Exolrec 06/10/2024
(Signature of Notary Publi
�.y� Notary Public State of Fior da
era ��ossman
ommission No. My L�emmidsm GG 983060
•'q a n Expres 05/10/2024
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.