HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� c LUU
TOT,
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
PERMIT APPLICATION FOR: ��0�(Ll�far✓'�l�Ylf-
�r
3 ..
P VEMENT LC7CATtC3N, A ECsS�4s}� 4 x
Address: -jF;,M hb I 1'✓ Ave, --
Property Tax ID #: Q"51�� d �� " I Lot No,rl
Site Plan Name: Block No.
Project Name: Lono
n
s t
160rt47 f �S
New Electrical Meter Second Electrical Meter
r
x ON
���G .QQY� & i 5
..C...
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: $ Utilities: —Sewer —Septic Building Height:
sxHIM
3
_
.tQ�QE2
Name L yQJ bt'C'n vi
Name: _ e-M V Grpsw(w()
Address: P a
Company: f/17�5� ��t21�1 lurr co&wunt m
City: Stater
c
Address: t
Zip Code: 015Fax:'71Z3gO-q-77-'�
City: Lle Stater
Phone No. ��Z�3G%� �7Z�
Zip Code: Fax--77-7 3TLS17Z?
E-Mail:Q'ri'225,f—T 000 Cii.0 9 C0M(_n'Sf X)_e- f'
Phone No"'7_77 --�?9'g? -(%' 1 Z55_
Fill in f e simple Title Holder on next page ( if different
E-Mail �I/DSSYY'tnp��G��S� ��'hef
from the Owner listed above)
State or County License,
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 commencina work or recording our Notice of Commencement.
Sig, f Owrtr Lessee/Contractor as Agent for Owner
S n, dtuye 'Cont ac or/License Holder
STATE OF FLORID
STATE OF FLORIDA ,
COUNTY OF l,C c(;i
COUNTY OF e
Swor o (or affirmed) and subscribed before me of
Swopi to (or affirmed) and subscribed before me of
V Online Notarization
Physical Presence or Online Notarization
this day of 202Z by
Pl�sical Presence or
this day of �Qt/1 feCL r l/ 202 Z by
�
�—� �! Vh
•�r� v Cr�f�55t�1�1�.t a� [>1
_��— �r'�f?,fC.c.l�
Name of person aking statement.
Name of person m king/statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
_V/'
Type of Identification
Type of Identification
Produced
Produced
' Q �
//�u�
(Signature off Notary Publi (Signature of No771T
Notary Public State of Fonda otary Public State of Floc da
Crain A,Grossman
Commission No. Jossman
My iataon GG 98�086 ommission No.y LommlSsuo„GGga306o
Eroues O5�t0�202a
��� otres 0500/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/20