HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i L t_ c
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: I
Address: z/5- EASTy knTT //l #&,L AVEf'_ 0kT
Property Tax ID #: p?!V,3Z//-J-01-00 ,5�2 -010-3
Site Plan Name: ST mi� s )D j x 230� 3 L s
Project Name:
DETAILED DESCRIPTION OF WORK:
� _ ii fi � • // E
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No._
dock No.
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
4 Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 15m, 00 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE: ::�l
CONTRACTOR:
Name Mm AWEN LIM U-C
Name: WhYme
Address: L7VW z
-
Company:eMd�e�iL
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City: TJOU57A- State: J L
Zip Code: Fax:
Phone No. E-
Address: /SD%Jlit/
City: C/
Zip Code:
Phone No -
State: �L
Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail GGS /7?Ci! . CZ/71
State or County License r✓
IT value of construction is ZSUO 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.
DESIGNER/ENGINEER
Name: _
Address:
City:
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
ICTION LIEN LAM
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip: _
Phone:
Not Applicable
State:
Not Applicable
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 attornev before commencine work or recordine vour Notice of Commpnrpmpnt.
Sign at 6ff qsolw4cfor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY ST
OF
Sworn to f pr affirmed a subscribed bef re me of
s thi
Physical Presence or Online Notarization
ay of 20bby
w/1 YNE
Name of person making statement.
Personally K own X OR Pr uce dentification
Type o7d, tifjcati Produced XL�P��
(Sign ture of Notary Pub Ic State of Florida)
Commission
Notary Public State of Florida
J. Simone
No. (Seal) ,P Kimla
My Commies°^ GG 957803
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Expires o5/1 W2024
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
%ev 10/12/2-1