HomeMy WebLinkAboutOlmeda-Permit Application (1)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: & ?d Permit Number: _
`�o L,U,CllL
uuxro
P a c e -c c 6 = Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 61 /2 -Ft4!'gCA y6c-k
Property Tax ID #: .3g6a " & -- bv;% ' bbd
Site Plan Name: znd,&n
Project Name:
DETAILED DESCRIPTION OF WORK:
'25'a T6( Szc
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
eo
Cost of Construction: $ f'q
—Gas Piping
_ Sprinklers
Shutters
(Affidavit required)
Windows/Doors
Lot No.
Block No.
Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S.o5K"-G- ( G-
Name: V,1�
Address: L le a 3�c'Iw 17C-.
Company: mug (-\
City: fort State: fL
Zip Code: 3%A9gra, Fax:
Phone No. (.5(,1) 513 - &SS k a E-
Address: (k 3i L-QV- \N0c�\'L' V-D.
City: State: IC-L
Zip Code: 33L-\ (4.3 Fax:
Phone No Ls,-1 O b
Mail: -S6\M---�$LA G�01�'\ •%r)-,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail e o1,rv< � ^i &-1e ' bi S 'krr.tb
State or County License 1� .
IIf value of construction is 2500 or more, a RECORDED Notice or c.ommencemem : is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not A plicable
p MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Pho 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 ana Instanavon as InUIGdLUU.
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
�L __ __ — r, .-C- - .,.,.,• —nnrina ,e,nrk nr rPr-nrrlina vnur Notice of Commencement.
with Ienuer or an al.Lui ney11e VI C 1 V1I II 1 ICI. n - -
Signatu a of contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF 31Ipt. RCk"�
Sworn to (or affirmed) and subscribed before me of �—Physical Presence or Online Notarization
this day of 'b2C svnV)QA_ 20 by
Name of person making stat ent.
Personally Known OR Produced Identification
Type of Identificatio Produced
(Signature of N P blic- State of Florida)
CO No LILIAN M OR=__A-,A(Seal)
Notary Public • State o` F.oriaa
mac` Commission ; HH 187012
or � My Comm. Expires Oct 15. 2025
Bonded through National Notary Assr.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21