HomeMy WebLinkAboutBUILDING PERMIT APP - St Lucie BlvdAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
9-�o LPL C�l1L
oF I�r
IJ n 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 IMPROVEMENT LOCATION:
Address:I�
Property Tax ID #: ��fj °v� %% ( � m 0) =) - Lot No.
Site Plan Name: - D �-21,¢as CArv�° n-6+ k-'an N 5' )-4-(— Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
r tUlr r -r .
New Electrical Meter Secon Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
— Electric _ Plumbing _
Total Sq. Ft of Construction: �a _
Cost of Construction: $
Sprinklers
Shutters _ Windows/Doors _ Pond
_ Generator ,Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name . li�St"sue �-' �. ��% L
Name: is
Address:,�_� ,�� R
�T— ��
City: e-� erc- � State:
Zip Code: Y�7 J fe Fax:
Phone No. V O -11S2 E-
Y
Company: .•t7�T/ //�=i�t1��
Address: �a5� Sn,iT,fy5 ,} W�q
City: Pl1N Pkrc.-e
Zip Code: V6 Fax:
Phone No 7
State:
Mail:
Fill in fee simple Title Ho der on next page (if different
from the Owner listed above)
E-Mail✓),�L;a�'������r�za,
State or County License
• - ....,....,,..... ......� r..�aiv vl IIIVI c, a nC\ %jnurLi IVOLIGe OT LOmmencement Is required,
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _j/Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: JZNot Applicable
Name:
BONDING COMPANY: —/Not Applicable
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 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 IPnr1Pr nr an attornev before commencine work or recording your Notice of Commencement.
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Signature —of ertu o Contractor- or -Owner Builder as icable
STATE OF FLORID
COUNTY OF �r L
Sworn to (or affirmed) and subscribed before me of
Physical Presence
or Online Notarization
this day of,�y 1✓7 20.W by
11
L.t�l coT C-5
Name of person making statement.
L/
Personally Known OR Produced Identification
Type of Identification P " uced
(Signature of Notary Public- State of Florida)
Srr/W
4 r
Commission No. 1��d��� (Seal)
��L%
.�r+ w, Nc,:sn PUb110 State of 1 kx;rL'i
f� 'r Garman M Quinones
My Commission "o ry93277
Expires
of
021IW02b
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21