HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12JP(7,2-- Permit Number:
o
Building Permit Application
Planning and Development Services
Building and Corte Regulation Division Commercial Residential
2306 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: Wa+-.e - R eel'. Charm '-e, Out
PROPOSEI JMPROVEM ENT-LOCATION -
Address: I , i Z G i l�.On PCB W OA A �9191
Property Tax ID#: 442-5 - 3 1 z2 6001 e00- '45 Lot No.____I�
Site Plan Name: Block No.
Project Name:
QETAILEUDESCRIPTION OF WORK:
- �Lx � !
New Electrical Meter Second Electrical Meter
CONSTRU-]OWlI FI ORMATION:
Additional work to be performed under this permit-check all that apply.
`Mechanical —Gas Tank —Gas Piping _Shutters i Windows/Doors _ Pond
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ go Utilities: —Sewer'
_Septic Building Height:
'C)VVN ERJLSSEE:;' CONTRACTOR:
Name I .IYILZ.r L �a Mj5 Name-
_
Address:? 0,9 1A&S -a Company: f- k&A -I-he-Fim U K `-A<f
City: &�Rednn State: ;rL Address:Ii53.1!5 IVY Weije�C 8 �(
Zip Code: 33`L3T Fax: City: Rr�- "I-<aCt Stater
Phone No. - 3 ;3-- (0077 Zip Code:34q5"�- Fax:'71_11
E-Mail: Phone No'-1 7° 2Z2
Fill in fee simple Title Bolder an next page(if different E-man,ntt-AA l�1eQ D]t1 r d�rY)
from the owner lislea above) State or County License
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 LAUD 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: _ 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 nd posted on he jobsite before the first inspect' n. If y intend to obtain financing, consult
with der r an attorney/before commencingwork or rec Noti of Comrpencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Si ature of Contra ctckILicensere r
STATE OF FLORIDA STATE OF FLORID
COUNTY OF i L UCA C CoL)n ,,i COUNTY OF ,
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization ✓Physical Presence or Online Notarization
this-k�day of "c v«.� 2-W4 by this21'°"day of
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
G�
(Signatu f Notary P bt` _e of FI~4 C PARKER (Signatu f Notary P (:Mof FIotYY�$µlE C PARKwR
Notary Public-State of Florida Notary Public-State of Fiorida* '° Comi `HH 041279 m�tCommission No. ?Fr MyComm! ies sec t0,2024 Commission Na. .. commi�� �+04+z79
My Comm.Expires Sec'0,2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20