HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APP IION TO BE ACCEPTED
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Date: /� � JqN Permit Number:
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�= Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Resid enti a l
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: ,
Address: br-
Property Tax ID#: ag33 -6O I — 000 (6- 000--(o Lot No..
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: 1 I
1�
New Electrical Meter Second Electrical Meter (Affidavit required)
FCONSTRUCTION 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 r _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 16ZO,670 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1 homas F je-k Name: L—)Ck' ',L
Address: 5Lu ae-4 L')e,tm P L Company: -
City: State: F?-- Address:
Zip Code: 3 q 9 g Fax: City: S�. ('n Elc State:
Phone No. 772 -3Z3- Q,�-33 Zip Code: (A GIST Fax:
E-Mail: 604 eJ. C Phone N4:3gZ) i7.P, — c--I Z j
Fill in fee simple Title Holder on next page (if different E-Mail rX c all
from.the Owner listed above) State or County. icense
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:_ v
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 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
STATE OF FLORID
COUNTY OF �:) . (i S�r
Sworn to(or affirmed)and subscribed before me of oL Physical Presence or Online Notarization
this day of ,20_ by
I<,--)CkCA r 4B0V I C4
Name of person making statement.
Personally Known OR.Producedldentification
Type of Identification Pro ,uced
lI
ignature of Notary lic-Sta of I i , 10..
KIARA S FIGUEROA
Commission No. �` N(fteal)Public-State of Florida
:► �= Commis sion # HH 51970
My Com mission Expires
October 08. 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev5/20/21