HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � I " � — �tl L.1 Permit Number:
SEL L-L (.1
01JhJ9`'
i-, - •_ 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 11 MMM r r`r I erC� FL. I, 3 `�
/�fb
Property Tax ID #: 0 U " , " OM " dwL(, " JC Lot No.
Site Plan Name: Block No.
Project Name: arm d rth
DETAILED DESCRIPTION OF WORK: 1
C kw I CL, i r1
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
r,r
Total Sq. Ft of Construction: u ] oll Sq. Ft. of First Floor:
Cost of Construction: $ � ��W q W . Utilities: —Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
-
Name: o-n1
Address: f—,
r �C•
Company: u[ l S on IoLr\"
Address:��j Jt fF" !� p -UGC
city: '• LQL.(Oi.MCI We, State:RL
Zip Code: _3331 Fax:
�
City: W 1 n 'T Uytn _ State: PLI
Eax-
Mail: Phone No `yQC1 ggLly
Fill in fee simple Title Holder on next page (if different E-Mail liifo L o COO 5i " Uc_-t`Ia) mam
from the Owner listed above) State or County License CCIC 16 2 S I
I
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:
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 OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
ove ents to your property. A Notice of Commencement must be recorded in the public records of St.
Cv my and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
�Wwitclrleh'
er or an attorneybefore commencingwork or recordingour Notice of Commencement.
Signature of ner/ essee/Contractor as Agent for Owner
STATE OF ORIDA
COUNTY O P�IIL
Sworn to for affirmed) and subscribed before me of Physical Presence or Online Notarization
this � day of,f,I 004t ],,/2C•1 by
j
'i'w &.4an Dl-ltw1/
FIAMS _ (r.
Name of person making statement.
Personally Known _/ OR Produced Identification
Type of Identification Produced
(Signa ur of Notary Public- State of Florida)
�� I OD �(v^� �+'* JERF Y LOAM
Commission No. d� (Seal) NotiryPWk-Stott of Florida
Commhsbn M HH 100562
3, - "P Mar 4, 2025
My Comm. Expires
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21