HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: t---- �� Permit Number:
RECEIVED
0
Building Permit Application DEC 6 8 21022
Planning and Development Services
ST, ucie C ty, Permitting
Building and Code Regulation Division Commercial Resid
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ;a% ..7 Z �< S�lt/1 f _ 6a
Property Tax ID #:
Site Plan Name:
Project Name: _
Sol 006Ie�2 ova
DETAILED DESCRIPTION OF WORK:
/1W
e
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 _
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 8/ 6, g .7 Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors _ Pond
_ Roof Pitch
Cost of Construction: $ 6 Utilities: —Sewer _Septic
Building Height: /
OWNER/LESSEE:
CONTRACTOR:
Name 41 ,J 4,/
Address: )
Name: AA
Company:
City: State:
Zip Code: 74/ 11�6/ S Fax:
Phone No. 172,;�'Z 11 Z,l
E-
Address: 5:
J
c
/
City: Il /
Zip Code: 3e1 '57e/ Fax:
Phone No, `7 )2
State:
�
Mail:L Z y /�O1 �o✓�
�N
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail —S 0nz-Je A i 62yY J
/QD% • ��
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not A plica le
Name: -e S
MORTGAGE COMPANY:
Name:
Not Applicable
Address: AW 2 &Z 56,
Address:
City:
Zip: Phone:
State:
City: 67er e e J State:
Zip: Phone /2
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY:
Name:
Address:
City:
Not Applicable
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 lender or an attornev before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Swor o (or affirinediand subscribed bef_org me of _ Physical Presence or Online Notarization
this day of AWC 20 by
Name of person making statement.
Personally Known OR ProclqLad Identification
Type of Identi 'cation Produced
(Signature of Notary Public - State of Florida)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21