HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date) Permit Number:4L1a3
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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: QQ \ n
14
'PROPOSED'IMPROUEM N ("';LOCATION -
Address: JLA-1_1- N . W ( %e QL jr-L
Property Tax ID #: Y�(�
Site Plan Name: 15Gnu �`EY1YYlA\J -`A A 550G • Th C Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ 3 dad .Cj d Utilities: = Sewer _ Septic Building Height:
RAC.,OR
-
Name 5 V
Name:;�1f tS P�irnson
Address:. 1
�YtC� Company: kan Zow
t0�
City: 2 C C ems. State-l@
Address: L�g 1 N-Q'p e Cq& -N
Zip Code :3 �: Fax: DM SjC(dA���JO
Phone. No. E-
City:-�Je�OL1 i LAYS
Zip Code: 32c15'9 Fax:
PhoneNo�� 2,� Li'��J-��S�J�i
State:ae
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MaC 5 �<<l�. �1f`f�
2�imple'Title
Fill in Holder on next page (if different
E-Mai(5)gMa.1 J
, CO (6
from the Owrier listed above)
State or County License Cbc_ '12" 1
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IT value or construction is zSuu 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.
a � i
`DESIGNER/ENGINEER: 1�—, Not Applicable MORTGAGE COMPANY: Not -Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 'v Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
zip:, Phone;
VNot Applicable
.OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit fo 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 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.
for
Signature of Owner/ L ssee/Contractor as Agent Owner
STATE OF FLORIDA n
COUNTY OFo��
Sworn t (or affirm d) rid subscribed before me of V .
this nay of b 202L by
Physical Presence or Online Notarization,
c)h �pd I a he'
Name of person making statement.
'
P s ally Known . OR Produced Identification
ype o�Ide=duce
�i �A���
(Signs re of Notary Public- State of Florida)
<►Rrpoe` JULIE BARRETT.
r ., .: Notary Public - State of Florida
Com ssion No. eal
q`'a Commission # GG 243242
My Comm, Expires Sep 28, 2022
Bonded through National Notary Assn.
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Rev 5/20/21