HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 k'y 7-,L-PermitNumber:
L U, Ct
Building Permit Application
Planning and Development Services p
Building and Code Regulation Division Commercial Residential xY
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Z t12- r/3 G (.1eS NHS 1^ w4 h
Property Tax I D #: 3 It 7-0 - (o p OU - t Lot No. (o
Site Plan Name: iF/L161M4 Block No. JWQ
Project Name: P154 tc-1nrjs
DETAILED DESCRIPTION OF WORK:
ADo1wc IVFw t7se- J1 C4rF0 ac v, r Lj t°L(ktC'
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
-,"Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
(Affidavit required)
_ Shutters — Windows/Doors Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ 12 5U . N Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name MI1-F_ (4<lt.1c1n1S
Address: 2 12_ r546i-t'55,t atif' r Iig.y
City: Pohl r Sr (-4j C 1A'- State: 9-
Zip Code: 3114,5 L Fax:
Phone No. 5 ) 1 - 2. 7 7- 3 31 S E-
Mail: 'JP1rA1Gti,1 1040 t_ . C oM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
56I40
P4111C2y7-
Company:
F1.1fry
YStA-C-I'trc A,va ,q-1rL
Address:
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City:
Zip Code:
Phone No
(26ttLr Sr L dC 1 >! State: "�-L
3 y4t y Fax:
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E-Mail 12i.n isirt,1'�.
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State or County
License_
F C 13 Q(3 (003 &
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 MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: k Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
c Not Applicable
State:
x 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 attorne before Commencing work or recording our Notice of Commencement.
Signature of ontractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF S f Lo t t E
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this 2'S day of SAIJ04-4 ti , 20 Ley
JJ014 N
Name of person making statement.
Personally Known X _ OR Produced Identification
Type of tification Produced
(Signature of Notary Public- State of Florida)
Commission No. {-blot bV 3 i (Seal) � 4; KONNI LENAE DEWITT
«� Notary Public -State of Florida
y Commission # HH 165134
My Comm. Expires Dec 10, 2025
Bonded through National Notary Assn.
1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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RECEIVED
DATE
COMPLETED