HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 LOCATIC
Address: �� ((�
Property Tax ID #: `i' i -! -Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
-0Ce--
�4GiS
(Affidavit required)
Lot No.
Block No.
i—,° u I
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 311Z � � ILPitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
�''�
CONTRACTOR:
Name �� r'1 % ' C1 Y
Name:
r� __
Address:._)(-� Jy W oA-2a.�, Cam' X
Company LJlY hG
City' R)Y 4�l� State: ��-�
Address: 'zy
Zip Code?r�s190 Fax:
City: C.� State: -� -
Phone No. `��Z - 233 E-
Zip Code:. _- O-�) Fax:
Mail:
Phone No ^7-7 2-- I[(Q (/) - f VZU
Fill in fee simple Title Holder on next page (if different
E-Mail \�NZ6:+MAJh)�I\6Y6*r"0, ►e✓GY�'1
from the Owner listed above)
State or County License CC C 052
If of
- -- -- ---- -- ---- - ... P — UC Uw11IIneMANIMni Is requlrea.
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:
nwmj:Rl rn1UTRArTno AccIrnirr.
....... ......—".. „NN„LdL,vn is hereby mace 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 le tlder or an attornPv hPfnrp rn► monrina ui^rb — ..,..._ hi_a:__ _r __
- - ---...... .. ... ..., .., _W1 u11 Irn YUU1 iMUuUC vi wrnrriencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
�sical
Swo o �
(or affirmed) and subscribed before me of Presence or Online Notarization
th is4`day
of �C (%ry.. �' 20 Z i by
l,
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Name of person making state ent.
Personally Known OR Produced Identification
Type ''f Identification Produced
(Signature of Notary Public- Sta f Florida)
FELICIA LYNE WILKIN
Commission No. _/�/I y ( ) ?°,meµ �Q` Nota Public - State of Fiorida
�� � Seal as � • = Notary
Commission # HH 160538
My Comm. Expires Sep a. 2025
Bonded through Nationai Notary Assn.
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