HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I • Ic %Z-
Permit Number:
1 L-LLCLL
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U � 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: 'F3� C1 2� (2;,lac c Yk&A C-fI L
Property Tax ID#: 34Z-S--7c)I —002I -Ooo-'I Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
JElectric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: M
Cost of Construction: $ 2 -y 0 .
_ Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OW N ERAESSE E:
CONTRACTOR:
Name - I
Name: M 64iazA Po 4-
Address: C ry 7r
Company:prid, lazc+�
C<P Gu✓.1, a,r F-L
City:Ci VU,v,r.(A0L( State: P
Zip Code: 1 1225 Fax:
Phone No. E-
Address: 0+2, S Lirrr
tiw-r
City: F P
Zip Code: 5114 q 5
Phone No -�-7 Z 4 b 1
State: FL
Fax:
2-7 3
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail m i" P h r i Le -
cAe�fi-{ c.,Q - C or-7
State or County License t;c-
i ;,, a c, S BS'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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 ggrantingB a permit will authorize the permit holder to build the subject structure
which conflicts with any, applicable HomeownersAssociation 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 pr y. A Notice of Commencement must be recorded in the public records of St.
Lucie County and post on t jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an att nev b ore commencine work or recording vour Notice of Commencement.
�'
SiJAZ
a of Contractor Owner Builder as applicable
STATE OF FLORIpI�
COUNTY OF �} JX /U �
Sworn to (or affirm and subscribed before me of �hysical Presence or —Online Notarization
this � day ,ono," rnd . 20 by
Iof
n
"krM.o�c.0
,cy-I,dxx
Name of person making statement.
Personally Known V OR Produced Identification
Type o ntification P duced
(Signs a of NotaryPublic- State of Florida)
Commission No. "V 7K,7(Seal) t David Raymond Prue
NOTARY PUBLIC
STATE OF FLORIDA
"• CorrowGG287052
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Rev 10/12/21