HomeMy WebLinkAboutBuilding Permit App - updated FFat
BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�I� Permit Number:
71
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c E ° M C I✓ p --�__ 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: ' = -
Address: q(Q �- Ea&me- Cwcu
Property Tax ID#: 3 a-a- 0 v� oU ( a-O O 0 + Lot No. _
Site Plan Name: I Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ISe IVt
i
New Electrical Me er Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION _-
w .
Additional work to be performed under this per
mit-check all that apply:
Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
/lectric Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft.of First Floor:
Cost of Construction:$ t ai � n,'� Utilities: _Sewer _Septic Building Height: Y�.
CONTRACTOR:
OWNER/LESSEE:
Name S n W '._ ►'''► 1'( Name: 1
rr_ls C �Q� Vwdk Company:
Address uo� ► C.. Q�1[�gW DTIyt
���- Lu,�Q Stater Address: -, L
City: �( � 110 npQ, Sate
(-
Code: !�� � Fax: City: L
Zip
E- Zip Code: Fax:
Phone No. Phone No _D 0
Mail: r� t
Fill in fee simple Title Holder on next page(if different E-Mail lC 1 from
m the owner listed above) State or County License e
is
0 or
Notice of
ent is
If value of construeon00 orOmore aoRECORD D Noti a of Commencement niss rqu fe wired.
If value of HAVC is$7,5
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Y ( M)MIf Name:
Addr ss: Address:
City: tate: City: State:
Zip: I Phone — L1 Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 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 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.
GFOr'
Signature of Contractor-o caner Builder as applicable
STATE OF FLORIDA
COUNTY OF TQ1M C'�eS.�IC{rl
Sworn to.(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 3DMy of D2C,U' VYU 20;L 1 by
Chad, bmssev:F
Name of person making statement.
�tii�►yp ,z TIFFANWY IES
Personally Known OR Produced Identification yY(�YMNS31ON#HH 108251
Type of Identification Produced }I� D(pIRES:March23,2025
aa�deA 1hrY Nat+ry Pudic UrdMwMua
(Signature f tary P(bl --State—of lorida)
Commission No. b X51 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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