HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l-1 /_c2 Z Permit Number:
c E @ �, c L:,. Building Permit Application
Planning and Development Services /
Building and Cade Regulation Division Commercial Residential
7300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT
� LOCATION:
Address: /,3 Z a Le V l'sia /i/-, i'l 10 5 e rL uC, i'e_ !-L J yq5�
Property Tax ID #: 3yad . 56W ° Q / 73 . 606. 3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Ike place 36 c1G /&o elecb- c, wn-ter be-afe rr
1;life fyr tllke,
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
— Electric /Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ f)
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 3_aaf7d, 0 rt ire z
Address: 13 Lal(e t& f~ lD 5
j
City: ! .SL State:
Name: arye
'Port turf 2
II6
Luei e Plumbinq
Address: Q of i
e Y
Zip Code: 3 Y q 5a Fax:
Phone No._ 7 7d 7 7 7- �g 3.3 `)GtViz' E-
City: __Fbrf S1 LL.cle State: FL
zip Code: Fax:
Phone No 77c2 g68-652q
Mail:
Fill in fee simple Title Holder an next page (if different
E-Mail Dorf uC6p_ D
I um 6, g ha I(. CO
from the Owner listed above)
State or County License
C, FC Q a a o� 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
DESIGNS
Name: _
Address:
City:
Zip:
Phone
Not Applicable
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.
'Z��Xw'
Signat r f erl tes eJContractor as Agent for Owner
STATE OF FLORIDA °
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of :�'A I , 20?� by
Ca Y y k/ ,Za na l la
Name of ptrson making statement. �
Personally Known V OR Produced Identification
Type of Identification Produced
a
(Signature of Notary P hc- State of Florida) ud"Mm Dow
_ cOIIII�i,#GG3 658
( ) ?ws
Commission No. tf04�5� Seal n: August 25, '�
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ReV 5/ZO/21