HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: ' Permit Number: 1
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Building Permit Application
St.Fermitt ngntY
Planning and Development Services
Building and Code Regulation Division Commercial Residential v,`
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERM ITAPPLICATION FOR:
I�RC?P6 ED IMM ROVEMENT LOCATIQN
Adldress: 13yS Love- Piyif- Sri - AFT- Pi 3ygZ2
Property Tax ID#: 023 4oci 50S DD), r7 D O o 9 Lot No.
Sit I e Plan Name: 0 a1-Scar, EnJ S to 44-o RiS,J4.vt e- - Block No.
Project Name: U)a4-!S u,n 16 Co T"Ta
DETAILED DESCRIPTION OF Oki W �kk''
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)I,.-L Q CL Sinalt �QM,Lj '3 ayd f.oarn 2) &L-Hn 446-,r����.
1N� 2 car 60—r- a5 t_
New Electrical Meter ✓ Second Electrical Meter (Affidavit required)
C0NSTRUCTIQN INFQRMATION > T r
r, m �.,
Additional work to be performed under this permit-check all that apply:
VMechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric V'Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: L'l A11 Sq. Ft. of First Floor: 32�3
Cost of Construction: $ q 55,6 23 Utilities:, —Sewer 'Septic Building Height:
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0111 NERf LESSEE CCI1V1"RACTOR .
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Name Mairvrn WjAkdn ���I z�8,e�h SCu o Name: MrcAtzL Di Fr&nces w
Address: 3f6cS LviI-d-etncS5 DriA31- Company:(ijEro.v%e-esta (oYsTi,1/4davx Xnc.
City: FT- ?� ,e rct State: Address: 92 Lfo Loneson+t Pfnc Tr&§'L_
Z.i p Code: 3 y Z Fax: N City: f T i-e rt� \ State:Ir -
Phone No. 777- Y61 ~ Zl7 D�1 Zip Code: 3 y Fax: -172 Lf b '72 73
iE-Mail: rry/-in ocQL@ ctoL.Covr. Phone N,op-17), ao) -7-1 � 7
Fill in fee simple Title Holder on next page( if different E-Mail i.��a eo�S +i C Q D L-, 66 v"
'from the Owner listed above) State or County License 9 Q ag a0 3 L a 1
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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SUPPLEMENTAL CONSTR3l1�"f10N3L1EN LAW INFORNiATlON'" `' n
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:AKI t� C46t,C. n z Name: j�l �-
Address: , 9ola PeLeivetut ;0-V-z Address:
City: FT ;ev« State. Jr-L- City: State:
Zip: 346jSa Phone y72 41.0 775'1 Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: 4= 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 tfie first inspection. If you intend to obtain financing, consult
with lender or an attorne fore commencing work or recording our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of 1 olI 2 1 by
Yr� i churl 8-sCL
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produc d
(Signature o Notary Public-State of Florida )
Commission No. (Seal) :o�P""?�:�; AUDREYB.HUMP
HREY
;.: MY COMMISSION#GG 300817
EXPIRES:March 6,2023
(�pJ "'••�;';;� Bonded Thru Notary PuNic Underwriters �1y.. u:�hT�f•L"""�tC'J[u='p.'�"•3c J�;Thiw.:+._I^Ht::3t!':`nir:,LL.•2�w^,)i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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