HomeMy WebLinkAboutApplicationAll APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �;-' `1 1 2- I Permit Number:
��V. LU;QLS
T OF
e ' 4 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:L� 1 ��
PROPOSED IMPROVEMENT LOCATION: _
Address: SU S . 0 4-J�rn ,n xL1't �2. }fie,
Property Tax ID #: 02-- o 1 - b0,& S -- coo � Lot No.
Site Plan Name: Block No..
Project Name:
DETAILED DESCRIPTION OF WORK:
v`t- 0, t LL 01 o 4- L
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric '�( Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 7-C7 Sq. Ft. of First Floor:
Cost of Construction: $ 500• 0-, Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A Cyl
Name: 'NAA
Address: aJ 5 ��.C-y+ �' C'DD
City: 240's Yl State: fL-
Zip Code: _ &A C7, 1 Fax: —
Phone No. S Q - A E-
Mail:
Company: ��YyYi U-vr b,J LL4�.
Address: i3
City: Jt,n 5 kzt",q State:
Zip Code: Fax: —'
Phone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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:
MORTGAGE COMPANY: Y� Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:_
Zip: Phone
Zip: Phone:
BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: _ 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 Assoclation 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, 1 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 undetgoing 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 prope ty. AN otice of Commencement must be recorded in the public records of St.
Lucie County and posted afe jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne b ❑re commencine work or recording your Notice of Commencement.
Signa e o Contractor - or - Owner Builder as applicable
STATE OF FLORIDA A
COUNTY OF
Sworn to (or affirm d) and subscribed before me of Physical Presence or Online Notarization
this Aaday of 2WIk by
(y) ►r ) irn Ik
Name of person making statement.
Personally Known 4 OR Produced Identification
Type of Identification Produco
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
KATHERINE LADEENE DODSON
.€ Commission k 00 339490
Explree September 25, 2023
o: 1 S=W Thru Troy Fain lnwrnna e00-395.7019
SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW