HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 k 113 12022 Permit Number:
'._ 1' 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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: _125q �eSev-Ve C'r ee�r`, "Ur•
Property Tax ID#: 3522 -COOI _0000 - 000 - Lot No. _
Site Plan Name: �Lmez' Block No.
Project Name: JC\` e5 CCU 5tn k
DETAILED DESCRIPTION OF WORK:
I n4k-n� \ rti6r) 6 - C `i . Q CC1��i�Grr1 �ln � _rc
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 _ Roof Pitch
Total Sq. Ft of Construction:�r Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Sell
Name: 03Mt �n-;�o
Address: �7�SerX
C-rf e h i L_
Company: o sy SII il)A-�t►' T_-
City: r2h,I(i-�- L UC (e C-0i n+i I State: f7/-
Zip Code: 59 8 (_P Fax:
Phone No. -112- BU2 - "1-12 E-
Address: Q1 `,_) W\N Oa,ad i' dr•
City: r - S604 L-VC% e State:
Zip Code: &0 Fax:
Phone No 112 - %GI - QQ ICI
Mail• ►(�1i I XXI U5e I 1 01 nrnnll • Cam
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail , i )a Sh waP p- yr P_ rV19('U I . Cov
State or County License_2�J Z
If value of construction is 2500 or more, a RECORDED Notice of commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC ION 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 TITLE HOLDER
Name:
Address:
City:
Zip: Phone:
/ ' Not Applicable
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 incaicatea.
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
...:+I, 1--A---, -- ,++-rnov hofnro r„mmonrincr %Ainrh nr rPrnrdinLy vour Notice of Commencement.
VVlIII 1U11U 1 o11----
Signature of owner/ Lessee/Contr for s Agent for Owner
STATE OF FLO�IDA
COUNTY OF �k \ v
0
Swor (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 20by
Name o person making statement.
Personally nown R Produced Identification
Type of I e tion Prod ced
`(Si natu'ee'vf Notary Public- State of F orida) ,o Pue, ALYSSA A.T. BOWSER
Commission # GG 295930
Commission No. (Seal) ';, ;��i;� � z Expires January 28, 2023
Bonded Thru Budget (votary Ser;,cas
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Rev 5/ZU/Z1