HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 Z Permit Number:
V Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial ')C, Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT'
ILOCATION:
Address: al ii I
Property Tax ID #: 1 (` i " Ct (L - OOq 4 " OOO ' c� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
a.' .
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
l
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: $ ri, Sid ' Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name I"t kt l L. dl
Name: ( AkA::
Address: N AiA Anf /W(
Company: 160AA, Air Cori �M I4 _
' 'S�i
City: Cn�x � D,-, 1&1,a A State:-
ZipCode: 31t4q9 Fax:
Phone No. E-
Address: 6ff 3 (o QJDlntWwLC X. -
City: State: PC
Zip Code: 3 Z-cL 4.o Fax: 17 X S7e Z' S3W
Phone No 71 J. Slel 2103
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rev w, bn Y• cue, 9 nn (00"
State or County License 0 JAC.ID
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:
Zip: Phone
City: State:
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 reppresentation 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
otice of Commencement may result in paying twice for
WARNING TO OWNER: Your failure t;AN
improvements to your property.Commencement must be recorded in the public records of St.
Lucie Count n o the first inspection. If you intend to obtain financing, consult
Jbfore
with lend r me befo ing work or recording to^mer Notice of Commencement.
A kzl(l
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Signature o Contractor - or - ner ti er as applical e
STATE OF FLORIDA
COUNTY OF —0 Q r
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 10 day of Jea— , 20 ZL by
1wN" n/C�>1c2 llAaFt%
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificati n Produced
(Si atu o y Public- State of Florida)
Com toNo. NCI 3I14- (Seal) °w„ IENNIFERGINADOLORESCRISANfE
MY COMMISSION 4 HH3174
M EXPIRES: May 25,2024
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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