HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
c Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Aven ue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Co 1 13 G.a:�Sick D�- i -,J G
Property Tax ID #1: �j� i - C P % L AP 3 -7 Lot No. 43 d-4%
Site Plan Name: �ian Block No_ Fl�,__
Project Name:
DETAILED DESCRIPTION OF WORK:.
'Bn
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: Ist e Sq. Ft. of First Floor:
CCj
Cost of Construction: $ O? 4;?o Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name���nh
Name: Ge,:&L4ri-�
Address: G H3 S t� Lr]t"
Company: to 41 �- i
City: - ?tea'`0 State: f--L-
Zip Code: ti:3498.�) Fax:
Phone No. �� - y(p E-
Address: 105 L . i1
� -r
City: (' �aeC State: F�_
Zip Code: L Gf & Fax:
Phone No 4q 0-Z
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail CN cl 0 �'� Ma i 1 • Co:�
State or County License �o
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: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE BOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 1 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
improvemen s to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie CounWand ppsted on the Jobsite before the first inspection. If you intend to obtain financing, consult
with le�id ot an attornev before commencinp, work or recording; your Notice of Commencement_
Sig a e of eontrar - or - Owner Builder as ai,, .)Iicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of cal Presence or Online Notarization
this 01 day of -sal , 20 baby
Name of person making statement.
Personally known _,,--�011 Produced Identification
Type of Identificatio Produced
(Signature of Notary Public- State of Florida)
I�{Seal) GAERIELLE HICKS
Commission No. "��',
.'t` �Notary Public -State of Florida
�* •- Commission # HH 79502
Ivly Commission Expires
r,r„« February 02, 2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12f 21