HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LU-1 UL
------- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial X Residential
CBDG Funding
PERMIT APPLICATION FOR: kyoo V *6n-zcw
n
PROPOSED IMPROVEMENT LOCATION:
Address: Iucy) S aa:1°1}�t
Property Tax ID #: LP50 2_'_ V --CCO_ Lot No.
Site Plan Name: Y � n C S<� Q Q Off) Block No.
Project Name: � Y l �1Ce SS andLm ��GQ7'e
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NEW, I'm
r -
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 _4 Roof f5 -I2-Pitch
Total Sq. Ft of Construction: 2192-- Sq. Ft. of First Floor: ,-432—
Cost of Construction: $_ DO Utilities: _ Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name ge ov i nca5 mam I n i uftl
Address: r
City: State: ,P
Zip C de: Fax:
Phone No. E-
Name:
Company:/tn'y_�Vwsfe vs' i V
2- Address: Zt1 7)1 n
City: V ern Firn(^' 1 1 State:
Zip Code: 2Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rI C h irCc I I ta f
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State or County License
11 Vd1Ut' VT GUnSLrUGLIon Is zouu or more, a KLLUKutu Notice or 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: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 4Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: of Applicable
Name:
Address:
City:
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 attornev before commencing work or recording your Nntire of CnmmPnrPmPnt
S gnature of Contractor -or - Owner ui der as applicable
STATE FLORIDA
COUNTOY OF S+-
Sworn t (or affirmed) and subscribed before me of
this day of ' - —(- 20�y
Physical Presence or Online Notarization
�/
Y - �( I U
Name 8f person making stateme t.
Personally Known OR Produced Identification
Type of Iden ifi ion P ced
(Si atur ary P c- §t4te of Florida)
Commission No. (Seal)
��aYPU KATHERINEHAVENS
?` MY COMMISSION#HH199309
EXPIRES: DEC 04, 2025
°� Bonded through 1st State Insurance
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