HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l - N- z Z- Permit Number:
L �..
1=r h co:c >o L 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: F l l� I' n
PROPOSED IMPROVEMENT LOCATION:
Address: � q a 1 SGa r bo r6 a h Gt orf 5 Lt4ci e J49
Property Tax lD #: �� a -D 7° O a r%� • baD - 7 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
e t n'C WG le_ r ea -r&- r
�,D r L;
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
Mechanical _f 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: $ /, q Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name GarDlo KasU
Name: ary 7,aflelLb
Company: Porgy' 5 Luti e-u
Address: d eri of 2 Dr
City: Fort Sf Lucle _ State: Ft
Zip Code: 3q 157.7 _ Fax:
Phone No 77a ft-&5a q
E-Mail_D8rf
/ 5e ba ro h G
Address: 9 q Z �
_
City: State:
Zip Code: Fax:
Phone No. E-
Mail:
Fill in fee simple Title Voider on next page (if different
from the Owner listed above)
State or County License I C. FC, L) 8a d a2 5;
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.
I SUPPLEMENTAL. CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not 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 attorney before commencing work or recording your Notice of Commencement.
Oderl Les e./Contractor as Agent for Owner
Signatrf 0
STATE OF FLORIDA
COUNTYOF__-{.I�
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this � day of R 20?� by
G ry kl Zana11a
Name of pirson making statement.
... _,,.._
Personally Known y OR Produced Identification
Type of Identification Produced
(Signature of Notary P i[c- State of Florida)
�011111i.l"7G6rJ$
Commission No. i7l�1.3 fs�o (Seal) _z
R
E>I S' Ai1 ist�25, 20
•r !I 11ti ��
B lWTMA VIi Notaryp,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21