HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP . �D FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 • om,
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: LOCATIQN
Address: S510 P0.1'rV6 'tD DV -; VC
Property Tax ID #: 3 q0;t -f..00 7 - O d 3 2 - 0 O — Lot No. i �{� 4
Site Plan Name: Block No. C2 a.
Project Name:
DETAILED DESCRiPTIO 0 WORK :;a
'A C-\ �1/�C �� // lI�_./4�� C 7 ✓C Ilk '✓�� . .�Y �� G�-•� QiACA i%
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New Electrical Meter Second Electrical Meter .(Affidavit required) O
CONSTRUCTION "INFORMATI.OIV
Additional work to be performed under this permit- check all that apply:
-Mechanical _ Gas Tank _ Gas Piping _ Shutters ✓Windows/Doors _ Pond
vElectric -Plumbing Sprinklers _ Generator ✓Roof Pitch
'Total Sq. Ft of Construction: 3,564. Sq. Ft. of First Floor: .3, 5G `t
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Cost of Construction: $ _3 7 5,(�1�� t Utilities: _ Sewer 4,4ptic Building Height:
OWNER/LESSEE '
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CONTRACTOR:
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Nam e :
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Name:
Address: J=c%M
r% -Or .
Company:
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City: - - �: t!c
State:
Address:
Zip Code: J q9 Vdk Fax:
City: State:
Phone No. 77� - ���3.5�
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Zip Code: Fax:
Mail:
Phone No
Fill in fee simple Title Holder on
next page (if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of, Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTLON LIEN LAW INFORMATION
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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 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 IPnrlar nr an attnrnpv hefnre rnmmencinq work or recordinea your Notice of Commencement.
signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 5t L,Ac,:e
Sworn to (or affirmed) and subscribed before me of t/ Physical Presence or Online Notarization
this 4� day of k�aJamnLjo.r L 20 2 1 by
r
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Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced �� n.S ' ,CA
(Signature otary Pu lic-State of orida)
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Commission No f" Navy PublicKU-NSuitEeRACWNFW A(Seal)
cortt 4610 i f 66 950872
•„ , , My Comm. Nofr6'Auy 22, 2024
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 5%1U/11