HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12_ 1 I -7 1 z�'L 1 Permit Number:
Planning and Development Services Building Permit Application
Building and Code Regulation Division Commercial )(1- Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: -' VI-t)-Al ! 1
Property Tax iD #: I V11 2.13
Site Plan Name: Cvvf:17-1 Y r FL-ALCC 1 JVs7-7,L/—
Project Name: =ALS rLYttc
FD—�TAILEDDE�SCRIPTION OF WORK;.
Lot No.
Block No.
1igLi11LL ?-?J `LoF—, [9l= -5 4 'r /�
779 Ll� �-i'L0-t % I.G.Ic 77f !ZX �JrLc�rfCl�
6-4-1 & W
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION -
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank Gas Piping
Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Shutters Windows/Doors Pond
Generator _ Roof _ Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ f5e 2- 86�-c�,,o Utilities: __._ Sewer _ Septic Building Height:
OWNERAESSEE:
Name Lr: um n v
Address: /9j-& C F= Aai-ck 4v,L - -r7k, 2u i
City: State:
Zip Code: 34 9,.1,G Fax:
Phone No. 663 4116
Mail: 'V9L)>: �sSLLk C
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
L-
E-
CONTRACTOR:
Name: As°f-tlittLC- i3i4-lLL-'Y
Company: A CaL-vT �,vC
Address: -7- % Afil Cell
City: oi,--ti S Lvc14 State: fL
Zip Code: 349 Fax:171 q00 z�
Phone No "772. 812
E-Mail i,-i1=0 f'ta
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 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 property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and pQsted the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an torn before commencin work or recordingour Notice of Commencement.
Signature of Cant actor -
STATE OF FL RIDA
COUNTY 01,
as applicable
L uciz
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 17 day of A t1LZ 20 2A by
T) At,Lt,.t e_iL Q-1+tLL-: `F
Name of person making statement.
Personally Known _ OR Produced Identification
TYp"f ldeat&� Produr_ol l
(Signaturt"o#Notary Public- tate of
Commis& No ' �Z (seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
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da
%a Nntary Public State of Florida
C 'y Stal E Naylon
4, Commission GG 929549
4t r Expires tl/Db12Q23
SUPERVISOR I P
REVIEW REVI
LANS VEGETATION SEA TURTLE MANGROVE
EW REVIEW REVIEW REVIEW