HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
g a o Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR
j PROPOSED IMPROVEMENT LOCATION:
Address: 4oci S nCQcA_.a-, .t
Property Tax ID #: Legal Descripticn _
Site Plan Name: 35 36 41 LISL.AND VTLLA43E PHASE 11 BLJ3G I L]NIT 29) FROM TNT W
RIWAIAANDSLl.SEC KIN S88DEG 37MTN29SEC WALGS❑SLI
37131 FT, TTi N 01 DEG 22 MIN 31 SEC W 486.04 FT TO POD. TN S 88
Project Name: O P.y -, (R- �� 2 p DEG 37 MIN 29 SEC W 55.8 FT, TH N 01 DEG 22 MIN 31 SEC W 16 F7, -
TIT N 88 DEC, 37 MTN 29 5FC W 55,8 FT, TH S 1] 1 22 MN 31 SEC' F 16 FAT
DETAILED DESCRIPTION OF WORK: TO PO -
C r cA iI2 Cam, `
New Electrical Meter Second Electrical Meter (AffiJavit required)
CONSTRUCTION INFORMATION:
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: $ 00 U c) Utilities: —Sewer —Septic Building Height- _
OWNER/LESSEE: CONTRACTOR:
Name-Av4c,sZ❑Se,r,,=_E �eVir,czo.zt7
Name: 1c,
Company: 3`,n, + ;r-❑ u k CU c+r, , L-Lrr
Address: Clo G I.e u d we
City: p'_Y-a a _Ck _ State: 6AA
Address:337a r)(
City: Lkv-'s.zn, i:�eaC," r- -
Zip Code: _0 � `t to O Fax:
PhoneNo.( E-
-...State:
Zip Code: _11q7 D F-axa�` I pL-poi-c2S10
Mail:
Phone No co -A �-s 4s-c- - Ys ,S - s 33 3
Fill in fee simple Title Holder on next page (if different
E-Mail � A t-_> 333 e.D e%
State or County Licensee `I
is required.
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement
is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
UESIGNEK/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit bo 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 Frantigg 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 FII 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 our Notice of Commencement.
Sig Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF CC v-
1 i Yl
Sworn to (or affirmed) and subscribed before me ofTliysical Presence or Online Notarization
this tl� day of - ar11 _-, 202-1 by
0, W �
Name of person making statement.
Personally Known FOR Produced Identification
Type of Identification Produced —ILO- -Dr tv-c r- l-I cc.-, Sfl—
n
(Signaturb of Notary Public- State of Florida) : Ps�Y K^RENCODERRE
MY COMMISSION 0 GG 9$1001
Commission NoG �l Sil btu (Seal) EXPIRES:ApdI23,2024
aadiLG.' Bonded Tin Notary Pudic Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED