HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. !" `] 2 Permit Number:
S ` L LLI cLl
' y ^ 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
Address: /-,?lv
Property Tax ID ft: iy
Jr • 60• 40
• Q
Lot No.
Site Plan Name:
Project Name: IA'
DETAILED DESCRIPTION OF WORK:
Block No.
G r .r /''Dll DZ 7d
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
✓ Electric (5") ✓Olumbin64) —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �06- Jr9 Sq. Ft. of First Floor:
Cost of Construction: $ �12�Utilities: ✓Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gera/dine
ge-Goul's_ Jddev
Name:
16 MIfIi
Address: SS<8.56
ZF
PUII ell Zg_
/�
f
Company: r
/�
f'14'llt& 9L a�
City-.. �,P6 t
Zip Code: g
Phone No. -710 • o
Gael' _ State
Fax:
,5V - OeK
Address- 6 ��
A�WtLnv Yed
City:
Zip Code:
Phone No y/9•
State:
Fax:
��1"/
E-Mail: lqc11 ;fi 1 Q holneshliC. 69&)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
,
1f 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 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 the first inspection. If you intend to obtain financing, consult
with nder or an attorney before commencing work or r"ording your Notice of Commencement.
0 1
"-h.
ignature of Ow er/ Lessee/Contractor as Agent for Owner
Signat e of ntractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF���i�]~//7
Sworn o (or affirmed) and subscribed before me of
Ph14
y ical Presence or Online Notarization
this day of A10Z 202/ by
ouI's I3dd e o
Sw9rr1_tP0r affirmed) and subscribed before me, f }A,
d/Phy icai Prese c or Online Notariza't�jz
o�
this day of 202� lay';'
rQ �/47n F/61)J1f4r7 0 9: z
UNan e of person making statement.
,.'Personally Known OR Produced identification
Name of person making statement. u 3 s r
g.
lF;Nn
Personally Known +1� OR Produced Identific�a.66
Type. of Identification �y7
-Produced FG DID f13Q�'S�3 ' z �� '�
Type of Identification
Produced °
m
� 1
(Signature of -Notary. Public- State of Florida }
(Signature e Notary Public- State of Florida
Commission No. GG a0lS F (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.