HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �7 �'��� ( Permit Number:
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' 1 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: r1 i63 Z C- _
Property Tax ID#.-332 --2- 1100 06(7> o®r.-� G Lot No.
Site Plan Name: Block No.
Project Name: bor_—
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
_Mechanical T Gas Tank _Gas Piping _ShuttersNindows/Doors
Electric _ Plumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $� s/ 3
5q. Ft. of First Floor:
Utilities: Sewer —Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Names"'-..4 VLt ur
Name:CJ(-�-I s
Address: ZZ--
Company:Cb � Z. ' cr�s C,^P
City: 3 i.i�C�U State:
Zip Code: Drla 1�Z Fax:
Phone No. q7_3 3'al 20/5- E-
Address: I S� ��t►eI �r'c.` � It
City: 'C7'�v e4' State: F7C
Zip Code j L11 TSi 17 Fax:
Phone No r) L 23'I Z
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail In-ED !� b��y -� L, Nn�
State or County License SAC_ Z3 a-& 3
i—(y L 150 01 `7
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:
Name:
Address:
Not Applicable
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
DSNot Applicable
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.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF�A� h
Sworn to (or affir ed) and s ibscribed before me of Physical Presence or Online Notarization
this day of '` , 2024by
Name of person making statement_
Personally Known X. OR Produced identification
Ty of I entification Pr duced
F
NiPture of iitary Public- state of Florida)
Commission No z- r' JOSEPFtBAf1lMt
a�-7 {Seal}
:,. My COMMISSION #-GG274212
,3 EXPIRES: Nove► ber 25, 2d22
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