HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: C) 1 Permit Number: . I `� C7�81'�
�_�tJ' l 47
[11- Building pp 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:
Property Tax ID #: � .� '`� O 3 — c or,-oo 14 S"' -C��• a l ci -
Lot No. S
Site Plan Name:
Block No. 3
Project Name:
[Qf:TAILED DESCRIPTION OF WORK:
"Tem r wer ole application, power of removed upon com I i n f work."
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
Electric Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name e ti yen tcerl� ti Name: ar gcr ec , �e -
Address: 4 Company:
City: 4--4_ State: � Address: ) )�� i cni FW x
�c
Zip Code: � y g o Fax: City: �� t ' a� -�� ,,
Phone No. - I I ` E- Zip Code: c - Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
if value of const^uction is 2500 or more, a RECORDER Notice of Commencement is required.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Pond
Pitch
ec, act _ -,-•-
State: _P'L
C
SUPPL MENTAL C0N5TRUCTIOnN tLIIrN LA1N`f'N (JR,NIAiT ON
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 permtto do the work and installation as indicated.
l certify that no work cr installation has commenced prior to the issuance of a permit.
5t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with anY applEcable ftrneowners 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 cf the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance witn the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following IaLiWing permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structi-es, 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.
:�
5ig&ture of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF _.LLM -
Swor o (or afUMMT2091by
before me of 4— Physical Presence or Online Notarization
this day o
Name of person
L OR Produced identification
Produced
(Sig11Z of &Aary Public -State of Florida)
Commission No6m_ - — at}
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ZONING
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COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21
`,q��;.y;.,, TONYA R. MILLS
_: °`r.- Notary Public -State of Florida
Commission # GG 918275
My Commission Expires
October 01, 2023
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