HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO VUST BE COMP4s_ -"'I FOR APPLICATION TO BE ACCEPTED 1
Date: /0 �Permit Number:
Building Permit Application
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annrng an eve opment erv�ces - 707.1
Building and Code Regulation Division Commercial Residential Nov C
2300 Virginia Avenue, Fort Pierce FL 34982 a " t
permitting pep
Phone: (772) 462-1553 Fax: (772) 462-1578 St. Lucie County
PERMIT APPLICATION FOR: �fe W cony , c_+j o,n
New Electrical Meter W-S Second Electrical Meter
CONSTRUCTIQN INFaR1 ATION
(Affidavit required)
A ditional work to be performed under this permit -check all that apply:
Mechanical / Gas Tank XGas Piping Shutters
Pond
_
,Windows/Doors
Electric Plumbing Sprinklers
Generator
Roof Pitch
Total Sq. Ft of Construction: --101
Sq. Ft. of First Floor:
go
Cost of Construction: $ 50, Do Utilities: X Sewer _
Septic
Building Height: / FT
y
AWIVER/LESSEs
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CONTRACTOR
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Name D6Lni-P,l aM t 1'101��2 QeAU 1 1 O
Name:, El 'jbY)tt (--° PK(®r
Address: �� n2:i_S/ _ % V .' """'
Company: (DMI C,�nJ�lwc.-�►�,� an`d pesi
City:' a— State: j-
Address: -1S5 iC ' C.-E- She
City: V&-D S� &LLK State: �L
Zip Code: _ 9Jr _ Fax:77a (4%-2GY)�(
Phone No. 17 Q -3 -5 _
Zip Code: 3M W Z Fax: M- lar - 1'33�
Phone No %iZ - Zy 2- i5 Zy
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Fill in fee simple Title Holder on next page ( if different
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from the Owner listed above)
Mail 1� Q� YDpe e- eS ,G M ai I. tzry%
State or County 613G !269 i 3 LF I
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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.
SUPQ�EMENTALCONSTIJCTl4'N
L�lENrLA1N' {NrFORMATION:
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DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not A licable '
Name: 0,f\c-ASso(.,jct: - s
Name:
_
Address: `)fir, Zzhd P I
Address:
City: Q 0LAo k State: P_
City:
State:
Zip: _j Zgi bO 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 vour Notice of Commencement.
T)_� nA . 1
1
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF F �t�n R 1Vi n
Swor t (or affirme409d subscribed before me of Physical Presence or Online Notarization
thiszn2L day of L T 20ZI by
�iGn�el_ M 1)ti LkLI-i
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification Produced
(Signature of Notary
a)
v--
Commission No. (Seal) .40 Notary Public State of Florida
My. Commission
N1657
16 J Bell
EXP. 8/4/2026
REVIEWS I FRONT ZONING SUPERVISO I PLANS I VEGETATION
COUNTER REVIEW R REVIEW REVIEW
REVIEW
SEA TURTLE I MANGROVE
REVIEW REVIEW
RECEIVED