HomeMy WebLinkAboutUpdated Application All APPLICABLE I FO MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 2 0 2l Permit Number:
9�o LC?CAUL =.R\
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b' 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:
PROPOSED IMPROVEM LOCATION:
Address: S d �d/-� /
Property Tax ID#: �d� 0 9 D Z 6 9 (/ Q O Lot No.
Site Plan Name: Block No.
Project Name:
ETAI ED DESCRIPTION OF WORK:
_
New Electrical Meter Seco d Electrical Meter (A idavit 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: �0/ Sq. Ft. of First Floor:
Cost of Construction: $ 0, o 00 Utilities: —Sewer _Septic Building Height:
OWN ESSEE: CONTRACTOR:
Name Imo/ Name: SC v C
Address: Sd,� J 1 e _07�!/ Com O-r
City: O�� /���xState:�L Address. ky/v. A_
Zip Cod M2_ Fa IV 0/LA, City: P_S_�, State: /C-L
Phone No. -77 Sd 6C E- Zip Code: Fax:
Mail: N")^_W� Phone No // 7 Z 0
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License h-D.14-/??
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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: _ 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 conflicts with an�applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consul t 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 lenderor an attorney before commencing work or recording our Notice of Commencement.
Signature of n r/Lessee/Contractor as Agent for Owner
STATE OF FLOR
COUNTY OF ,,,
Sworn to(or affir d)a pd subscribed befo a me of _Physical Presence or Online Notarization
this"day of =1 by
1
Name of person m ing statement.
Personalk Known OR Produced Identification
Type of de ification Produced
Si gnature of46tary Public State of Flor )
. Mc II
ExpwEs:oecunber zo,2022
B=Wnw Notary Pub nra.r.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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