HomeMy WebLinkAboutBuilding Permit ApplicationIPPLICABLEE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a`'1 �0�'� Permit Number: a..a.0 a r�
IMb�l�[IL FEB 017 Z022
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
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFO"RMATIQN.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: �100
Cost of Construction: $ 13 W
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name L.,Kr�S F- .%C,r
Address: lI't l S. �e,ka.^
City: �C' State: F-1.
Zip Code: �`{�,�'7 Fax:
Phone No. 't wi-f L ID3
E-Mail: C_1CoekLe4, ' 0Q Ua ". Cov %
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: J %#,
Company: Srhdkywr% Sc'ew. So ��nS
Address: -2 ra. Se "r% L4-%
City: I A 34. LUG. State:,
Zip Code: 14043 Fax:
Phone No ^7`1 -)OK- 9130
E-Mail Se�Sr�wr.ScrEtnS•�a�+�•sL� gllf�ar�I•ton,
State or County Licensee$
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORMATION.
,.,
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 0"',A . fnV,
'.,
Name:
Address:,S 6 0 ( Mo,r;rte sk
a 0
Address:
city: o.vp
State: F-I.
City: State:
Zip: 3360q Phone 6(3-314-a403
Zip: Phone:
FEE SIMPLE TITLE HOL ER:
N t Applicable
BONDING COMPANY: Not Applicable
Name:
\
Name:
Address:
i c
Address:
City:
City:
Zip: Phone:
Zip: S-7 Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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
withlender-or an attonwv-before commencine work or recordine vour Notice of Commencement.
Signature oUOwnerl Lesse67Conffiqor as Agent for Owner
STATE OF FLORIDA
COUNTY OF s>
Sworn to (or affirmed d subscribed before me of ✓ Physical Presence or Online Notarization
this/L/�day of 20 LZ by
Name of person making statement.
Personally Known OR Prod Identification
Type of Identification Produced iZo01Z_ F�2 s
(Signature of Notary Public- State of Florida )
Commission No. F3' (Seal)
REVIEWS FRONT ZONING
COUNTER I REVIEW
RECEIVED
�0%1 •o� Phfale *a d-NMh
• Notary PubBc. State of RAM
+� 1 Commroeton Explme 07/1MMO
w CWMINIon No. HH 180883
SUPERVISOR PLANS VEGETATION SEA TURTLE
REVIEW REVIEW I REVIEW REVIEW
MANGROVE
REVIEW