HomeMy WebLinkAboutFuller, terry permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/251Zz Permit Number:
n t . " Y Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential XX
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Vic.F_ cTnr��.
PROPOSED IMPROVEMENT LOCATION:
Address: iYS7 j41-- .0pWbpp p2-i✓F
Property Tax ID#: 1 317- SUI OU-21-Ul.U- 3 Lot No. 20
Site Plan Name: 1`ULLr_,L
Project Name: p'ut'i-i. F_ w Block No.
DETAILED DESCRIPTION OF WORK:
12(J/✓nJirt6 I N,`Lo Ctot(utr 9LK, MtCR.ocr�}�,�
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
-""E'lectric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name J t51t✓t-'7 Name: 50 4-N 199wita 4 2
Address:_ qY.'7 Company: 6Wra Fl F_crr(�C ArJ q�•1
City: State:Xi%L
Address: I(a t7( J w s o u rN F-t o Lx✓v
Zip Code: 3Y45-1 Fax: City: POLL f Sr LUC r F_ State: iCL
Phone No. 103-9' 3— 2(P&S E- Zip Code: 3t/etkY Fax:_ 71 Z- 3YJ-37oZ
Mail: Phone No '722- 3u„-
3-7G)
Fill in fee simple Title Holder on next page(if different E-Mail_ PF�/I µcc �"rF iF_G7n IcAWL') Q4t rC.0
from the Owner listed above) State or County License t C/300(,a31.
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:
DESIGNER/ENGINEER: C�Not Applicable MORTGAGE COMPANY: _,X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: F 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of RObintractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to for affirmed)and subscribed before me of Physical Presence or Online Notarization
this 2'5 day of_ I NUA-nN ,20 Z2by
1014N P,+njiset7L-
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida)
iY KONNI LENAE DEWITT
Notary rl Public State of Florida
Commission No. 1441for/31(Seal)
a Commission#HH 165134
My Comm.Expires Dec 10,2025
Bonded through Natioral Votary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 12121