HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: li`" 13-22 ___ 41�c-_ Permit Number: -aa5
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91T.LOME
Building P i6it 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:
PROPOSED IMPROVEMENT LOCATION:
Address: d
Property Tax ID#:���I ' �Q. " �Q%� 'Qa�^(� Lot No.T'45-
Site Plan Name: Block No.
Project Name: sHouj w2 .f'1 ,.e
DETAILED DESCRIPTION OF WORK:
"4 1' nf ch I rLrtpj (A n ole C,?
weo� d-c c� , 2e - it I �,,�� 01 4V 1 r)S461 � 1 rn heal
9h 1 r Ilt r ornity1 ci S-h G i 4V t2114 A100CI d,eC Y_ .
New Electrical Meter Second Electrical Meter
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 I Pitch
Total Sq. Ft of Construction: ) �i n Sq. Ft. of First Floor: Z'f0? 2
i
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:�—
OWNERAESSEE: CONTRACTOR:
Name Lo.rr Name: S• r
Address: 1 Company: I �.�
City: �&rn P_ rb State Gv Address: If 1�
Zip Code:=� �n Fax: City: 12� L,
Phone No. r- (D Q 2:7 Zip Code: B LI S-71 Fax: 1 Z-'337-'CI S�/]
E-Mail: Phone No 7 1 2.
Fill in fee simple Title Holder on next page(if different E-Maill• D i LVIS (' CA1Z0 r"L i?:JQD
from the Owner listed above) State or County License e C i' 03 a_
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: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner ure Contractor/License old
('J
STATE OF FLORI A :A�TE
OF FLORIDt
COUNTY OF AA, COUNTY OF L414 ClI �
Swoph to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
V Physical Presence or Online Notarization ✓ Physical Presence or ' Online Notarization
this]l�LNay of.TtA n Via 202gby this '�''"�day of n 2029-by
S-I-Ira�,d s n
Name of person w§king statement. Name of person making stateme t.
Personally Known V/ OR Produced Identification Personally Known y OR Produced Identification
Type of Identification Type of Identification
Produp.ect Produced
ign ure of Not i -S =nN
of Nota -
:S, JENNIFER DAVIS r�"��., JENNIFERDAVIS
ommission No. _ ""= OMMISSIIG953418 = � ''': MY60MMISSIONJQ@18
EXPIRES:February 29,2024 EXPIRES;February
• NOM Public Undeiw brs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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