HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1�5J 2 L
Permit Number:
S`, L uctLL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR: F, t r- 'm I
PROPOSED IMPROVEMENT LOCATION:
- a.1,.
rUui{ Z V I J V Gt A-N un,CVm ,q.(IT Lt-C_
Residential % X
Property Tax ID #: 3936 - 3 3 H ` 0o c, 3 - I s'o - Lot No.
Site Plan Name: G0 tf W��V Block No.
Project Name: G 0 tT W 4�J
DETAILED DESCRIPTION OF WORK:
9IQL-4 to L'IIe F_ L-I rc,e 1 2S AM fa (14-Al ANC
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
--'Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:$ 2282.7Y
(Affidavit required)
— Windows/Doors
Generator Roof
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
Name
6V4
Gun w4W
Address. _
`(yU l
s' QGF_4M Drti✓,e- 4 - C,
City:
SY:11J515.
6%A-c tt State: FL
Zip Code:
3 Y e O
Fax:
Phone No.
_
772- 21 i- E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Pond
Pitch
Name: Jb If N
Company: Fri I-("- Gr/ul c. 4,,,3 4,A_
Address: 1 (P'11 ' tLj S') ur d4 1-c,y <_vu cat,✓v
City: &A r S,- w c 1,5 State: r(-
Zip Code: 3145 811 Fax: '7 i2 - 3Y0 - 3-? e z
Phone No 111- 3q u - 37 9 7
E-Mail i'1c&t- &r P t,Ifi-�r I'- t,j,: n,c ,q-,ua q�n
State or County License 6C 130 bto u 3.4
IIf 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:
Name: _
Address:
City: —
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
zip: Phone:
jk Not Applica
State
ik Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
cL Not Applicable
State:
—Not Applicable
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 attnrnpv hnfnrc
OF icwrding our Notice of commencement.
Signature of Coeitractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF 'S.-
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this 2,5' day of T4N0s}4-t 20 24,by
50 4tj P 4 NlC Ij o Z
Name of person making statement.
Personally Known �s OR Produced Identification
Type of Identification Produced
(Signature of otary Public- State of Florida)
Commission No. 14If(b513 y Seal
(Seal)
e� . KONNI LENAE DEWITT
?�:` Notary Public - State of Florida
Commission HH 165134
9'acOE' My Comm. Expires Dec 10, 2025
Bonded through National Notary Assr..
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