HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I L `" E L' C_ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: uo no 3 Paso 12obi es 1�21urn • gnr+ Fi•erre, PL 5q,151
Property Tax ID #: 03`I2.-• 000 -2- Lot No.
Site Plan Name: Block No. I
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit 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 V Roof Pitch
Total Sq. Ft of Construction: 21!1153
Cost of Construction: $ 2_9 r ?jid . CT�t5
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lour
Name: �(Xm "by-o aos
'Aj1)►')r-1-n
Address: tP JUG I�Gr {� bb)es Ql U Ce •
Company:
siqr
City: F-f7 rt Pl-eY(•P, State: 4v--L
Zip Code: 'lq`T Fax:
Phone No. h,2) 5gLA — 5gb-o E-
Address: 1
p� or-w-e—
i��
city: ✓c,
Zip Code: 2w77� Fax:
Phone No(;2.) —
State: F' --
(42_'5"-)
Mail: ICU r7V 00 5-35 CCU) . iY)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail"
�l - S� 0�•
State or County License
1717-11-9(P
If value of construction is 25oo or more, a KtLUKUtU Notice oT l.ommen[xrnenL is IeyuucU.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name: _
Address:
City:
Zip:
NEER: ✓ Not Applicable
Phone
State:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
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 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 attorney before commencing work or recording our Notice of Commencement.
ctor - or - Owner Builder as applicable
Sign=FFLORIDA
ST
LINTY OF em I li o-le,
Sworn to (or affirmed) and subscribed before me of
v Physical Presence or Online Notarization
this I day of UCC 20�by
Name of person making statement.
Person wn OR Produced Identification
Type of Identific do ro uced
(Signature of Notary Public- State of Florida)
Commission No. at4 /g FSV3 (Seal) AL
Notary Public State of Florida
Paola N Lam Medina
My Commission
MH
�5/412025
Exp.98503
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Rev 10/12/21