HomeMy WebLinkAboutBuidling Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPUCA,-UN TT JO BE ACCEPTED
Date. ✓ermit Number:
Li CLi
_ - Building Permit Application �a/
Planning and Development Services y
Building and Code Reguiation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: S; --(b
PROPOSED IMPROVEMENT LOCATION:
Address: " Aq```1, Rz D `t Jci? sekl Beach FL 34957
Property Tax ID#: 4 1 0 0 2 2 19 0 9 -- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Pc:t, eckietiexe 6oi bacf patty exteki s< oil
4" tNticlz 3000r5i wAt'ber /LqX 2� ��%aX ,'a X !I
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 A Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _ _ Roof Pitch
Total Sq. Ft of Construction: 375 Sq. Ft. of First Floor:
Cost of Construction: $ 4500 Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
; Name - ' S'- "h Pier zufZcsh < ? Name: JOSc V JasB Co«chete
Address: 3% A q Company: l `R C o kI c.7 e t e P e i 'r tic,;; j
City. J e k �� "� B e a t It 33 State:F L ( Address: ��
_ A!
l S 0 7
Zip Code: 34957 Fax: N o kr e City: PS L e i3 e,,Mate:
Phone No. ' > l ' S��6 6 E- Zip Code: 3498 6 Fax: No r?e
Mail: j Phone No 7 7 240 6170
Fill in fee simple Title Holder on next page (if different E-Mail 25230
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement Is required,
tf 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 our Notice of Commencement.
Signature of Owner ssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF {� LJc�e
Sworn t (or affirmed and subscribed bef re me of Physical Presence or Online Notarization
this 3day of 20 by
Name of person making statement.
Personally Known OR Prod t d Identification
Type of Identification Produced
(Signature o Not ry Public-Staff Florida)
Commission No. (Seal) i' m
R BURFORDida-Notary Publicn # GG 183217ission Expiresry 06, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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