HomeMy WebLinkAboutBuilding Permit Application{ j �
All APPLICABLE INFO MUST BE COI! -TED FOR APPLICATION TO BE ACCEPTEI,
Date: Permit Number: ,2ao w 7
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Building Permit Application
Planning and Development Services oa�la�3b
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PRO.POSED-. I IVI PROVEM ENT .LOGQTLQN:.
Address: `g 9 n5,S H vN F I• 1 e-re-P, F i~ ci 3 `i 95
Property Tax ID #: ) �J I �J ' �j • 000 1 • 00 9 4 Lot No.
Site Plan Name: u4y Zone, -*3�v Q ,4 Block No.
Project Name:
;DETAILED DESCRIPTIQN OF WORK;
C
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCT[ON- INFO.RMA, TION: -
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
ZElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1,600,00 Utilities: -Sewer —Septic
Building Height:
all
"`OV1I.N :R/LESSEE:
.,,CO'NTRACT:OR.. "
Name 44--. c, -141 v)o Q--L
Address: 6 M . J c P�� &W
Name: J i n . MOM
I
Company: &-o ILO �Jne. SDA-e 4,,j 4 SFo i,lr � V
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City: 0 off lY l i a.,u ��crf- State:l-1 h
Zip Code: 33 I Le a Fax:
Phone No. E-
Address: f4 9 g3 S SA - S.S -! -
City: S . u 6r+ State: Lk
Zip Code: �S� 0) N Fax:
Mail:
Phone No qq Q. IM • o�3 P-a
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Af\ PA S �Qd'y)
State or County License C Fr,�060 0 1P e
it 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
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 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 your Notice of Commencement.
SignatJ% of Owner/ Lessee/Contractor as Agent for Owner
STATE OF ILLINOIS
COUNTY OF Dupage
Sworn to (or affirmed) and subscribed befcLre me of X Physical Presence or Online Notarization
this 29thday of Sept. 2021 by
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification•Produced
(Signature of Notary Public- State of Illinois)
Commission No, a1°p�FJreOcNsGueal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/Z0/23