HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Uo ��1�llL5
JA N ® 4 2E ,
Building Permit Application do L-ucieCounr
Planning and Development Services Permitting j
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: :SCtVrHgRd'
PROPOSED IMPROVEMENT LOCATION: l
Address: X1,06 'L
,/ i V.& E- �IPI�%�•
Property Tax ID #: _ 3Y doh " b VQ- o/ I r% O do -6- Lot No.�_
Site Plan Name:
Project Name: "! (tto & 7
I DETAILED DESCRIPTION OF WORK:
New Electrical Meter `/ Second Electrical Meter
(Affidavit required)
Block No. nr
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
✓Mechanical _ Gas Tank _ Gas Piping _ Shutters ✓Windows/Doors _ Pond
/E'Iectric _ lumbing _ Sprinklers _ Generator '1<0*0f Pitch
Total Sq. Ft of Construction: 1192o 1& 40 Sq. Ft. of First Floor: 02 5i3
Cost of Construction: $ 41"r, oU Utilities: —Sewer ✓Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
f j
Address: Ct
fli:Q' X6seY Q It M`
Wes:l 1J
City: i State:
Zip Code: Fax:
City: r Stater
Phone No. a� �j�10-� o S-A
Zip Code: J VAga Fax:
E-Mail: bilL& 5�_ _ I7W _ e0L"
Phone No n -1 zz
Fill in fee simple Title Holder on next page ( if different
E-Mail_ ►a ei d uL G91#4
from the Owner listed above)
State or County Licensees 1.464 A*7
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: 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 oral attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA �..-
COUNTY OF
Sworn t (or affirmed) and sub cribed before me of �p
ysical Presence or Online Notarization
this day of (%C78d, 20,9f by
Name of person making statement.
Personally Known V OR Produced Identification
Type of�lentificatio Produc
ARTHUR L99 CROSS
•��• •�ki.img puhile • state of PIMA
(Signature of Notary Pub ic- State of Florida)
Cort�mf�sion >�
Oct 2, 3Cg�
My COMMA Expiro4
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21