HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-'/A-3, Z02_-2_
Permit Number:
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
CBDG Funding
Residential
PERMIT APPLICATION FOR:
Fw CZ
PROPOSED IMPROVEMENT LOCATION:
Address: 116, t4 �
4r=i�l Lai„
Property Tax lD #: 3*ct Lot No. 22
Site Plan Name: CiZi2nvrJ �t i�ec� , L"';v rrXc� Block No, 5-
Project Name: .Li,�s.�g f'_If7trnf �. Krlc l�L7tlG L
DETAILED DESCRIPTION OF WORK:
kic Al.s-Jr LL 240Qe z- _ F_ vi= -5 'J.7�tL=JJitric( L, Ajt�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 76. on Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S6>AJYi4 nrr rs
Name: &4ttcuL'6-"
Address: i I L 1 AWoA- 4 Y�A.1
Company: A &h4-w i r-&Az cL-
City-S' LLc.i�` State:
Address: 7a l AJI;[ L Ti= rrP;lirc l r �/
Zip Code: 341;t.�;-2- Fax:
City: Po«i Sr Lizi State:
PhoneNo. -772- ,3Y'2- v %L.9 E-
Zip Cade: _ I/ M - Fax: i72_ 408 &2.-7 2.
Mail: I iVdA6`ar_LIti9 6�C�i� rLr40'rt
Phone No -172t3i2 e;z71
Fill in fee simple Title Holder on next page (if different
E-Mail i /J &—� x!
from the Owner listed above)
State or County License CGc_ i z ?Y7/
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:
Zip: Phone State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: zNot Applicable
Address: Name:
City: Address:
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 our property. A Notice of Commencement must be recorded in the public records of St.
Lucie County an' posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or n a Clmbefore Commencing work or recording our Notice of Commencement.
Signature of C rac -or- wne Builder as applicable
STATE OF LORIDA
COUNTY OF S; LucwL�
Sworn to (or affirmed) and subscribed before me of )L Physical Presence or online Notarization
this . day of .fie MU41c- 2027- by
rA
Name of person making statement.
Ily Known OR Produced Identification
ldentifimti�Prnrl ,.,4
Notary Public- State of
Commission No.
Notary Public State of Florida
.
Crystal F Naylon
Y
My Commission GG 929549
Expires 11/0612023
REVIEWS FRONT ZONING
SUPERVISOR
PLANS VEGETATION
COUNTER REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
SEATURTLE I MANGROVE
REVIEW REVIEW