HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: E U
PROPOSED IMPROVEMENT LOCATION:
Address: L , -1 r' — , ". ' ' I e r-0.
Property Tax ID #: Wi z, I - vcl - co 'SS coo oo -o Legal Description
Site Plan Name: LAKEWOOD PARK -UNIT 8-A- BLK 4 LOTS 1 AND 2 (0-57 AC / 24,800
SF) (OR 4296-0542) (MAP 13/02S)
Project Name: �y\-v� S at-�
DETAILED DESCRIPTION OF WORK:
'C c'� 1 r�
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
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $y o o - c) d Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameAc arr-% i C: u e
Name:
Address.U-1 LI'lYa.-) f g_u. r
Company: 5;y-rN 13rUw rLectv-%'c, CCL-
City: cc_ State:
Address: 33Sa o c 5 Kt� L-t �_k Dr- , c
City: cam;, State: F c-
Zip Code: 3y `r -Fax: —
Phone No.—D.-_1 '2 - [,p l iS - y ( E-
Zip Code: ?-[6i Fm!:
Mail:-A-V,-\\'5 ;S Cxc.cui— Q S' di.UutfoOw- ,cv.YN
Phrn*re NoCs` 5�"emu-'i(_,_3- `S 33 3
E-Mail ; d t, ' 33 1 .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
1
State or County License LL o F -1
_
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: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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
whfch conflicts with an appl]cable 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.
=nature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF_%2Na,__ a_
Sworn to (or affirmed) and subscribed before me of [Physical Presence or Online Notarization
thisl " day of , 20'zZby
v16r w(l
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced Icv-, c s
LC, c
(Signature of Notary Public- State of Florida)
Commission No.& G- `l If l Gu I (Seal)
REVIEWS IF ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
KAREN CODERRE
MY COMMISSION # GG 881001
g F.XPIRES:April 23,2024
FpF R'' Bonded Thru N,,Wry Public Underwrllers
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW