HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE IVIPLETED� AYPLICATION TO BE ACCEPTED
Date: JQN 0 Permit Number: 04ol
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P Building Application
Permit A lication
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: �E0.1>0 5LaeCID le
PROPOSED IIVIPROUEMENT LCiCATION
Address: IiLtbg VW[Ffkt.,0L PQ VC 3LA�kn
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Property Tax ID#: ��,0 6 4 3 LV om L2&AQ Lot No.
Site Plan Name: ���tt ?ti".�C� Block No.
Project Name:
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DETAILED DESCRIPTION OF WORK
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New Electrical Meter Second Electrical Meter (Affidavit required)
COUSTRUCTION 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 i X Roof 2 1 vz, Pitch zz-
Total Sq. Ft of Construction: /j00 Sq. Ft. of First Floor:
Cost of Construction: $ `(Z5_G- `v Utilities: —Sewer _Septic Building Height: 1
OINNERJLESSEE CONTRACTOR = x
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Name C-2N 65 i S Name: 5 00V_E1Z' CP1-61,t-N IF1'AA.
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Address: LlLtOV ww&-Cz6=cYz�- Company:eA6WN�� i uaJ� irtrc
City: la efig t>G State: ri, Address: ,t-Fur M--.V-1 Alm
Zip Code: 34114-7 Fax City: :T!c n,=VMIt Stater
Phone No. 1'1'L (61(o (4LA7 Zip Code:34ggC Fax:
E-Mail: Phone No —n --7 i 6
Fill in fee simple Title Holder on next page (if different E-Mail
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from the Owner listed above) State or County.LicenseL'GGrd5J3
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 INFQRMAT101
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 an posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len er a before commencing work or recording our Notice of Commencement. .
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF , C� CA
o � m
Sworn o(or affirmed) and subscribed befg_re me of Physical Presence or Online Notarization
this day of 2 20iTy
Name of person ma� OR
ings tement.
Personally Known Produced Identification
Type of IdentifiCRItion Produced
(Signature of Notary u i -
aaYW�,, ELLEN VAUGHN
Commission No. ;o,P U 1, State of Florid�ctdglpry Public
=* *_ Commission # GG 270079
e My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
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