HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2,1 T/ Z -
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X 2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding_
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION:
Address: 31 12 A -PP 2 U4-c- .- Sl4 d T W+
Property Tax ID#: RI-Y- ?0"7, 01197_ OUG-/
Lot No. 1(o
Site Plan Name: W#AJP µ
Block No. 41/
Project Name: 14/4744-
DETAILED DESCRIPTION OF WORK:
PP1,h 4N' 1r43ai.- 14 2=0 RMP QFviC*r'70 Li2Cvrr
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 _ Windows/Doors _ Pond
vElectric _ Plumbing _ Sprinklers _ Generator Roof
— Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ a 3�y. 3 5 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name
WAN4
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Address:
31 I Z
APP)10 �101 Sh6r Wg Y
City:
00 r sT
Ly c State: lit_
Zip Code:
3N';5L
Fax:
Phone No.
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Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: J JN-N 1714-M4Q !1 'L
Company: I�.LGi i� Fc F L�2cc q-,,�J 9rn_
Address:_ I (off/ 4J 40U1-44 i1q-C4-5du 1J4V
City: Pbr r J. Lt/Ci F State: FL
Zip Code: 3 Y q t y Fax: 711 - 3`(0 - 316 Z.
Phone No 71 Z- - 31l-6 - 3 -)c, i
E-Mail �F./LHci (!� ��tTi���i�rgiCANJAc2,CC
State or County License t C 1360 b o3 L
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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PPLEMENTAL CONSTUCTION LIEN LAW INFORMATION:
IGNER/ENGINEER: Not ApplicableMORTGAGE COMPANYe: k, _Not Applicable
ress: Name:
City: Address:
Zip: Phone
State: City: State: FEE SIMPLE TITLE HOLDER: Zip: Phone:
Not Applicable BONDING COMPANY:
Name: X Not Applicable
Address: Name:
City: Address:
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 attorney before commencing work or recording r our Notice of
L
Commencement.
CL/
Signature of Cont'tactor - or -Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF p "rr'e it 4 L
Sworn to (or affirmed) and subscribed before me of
this --&' day of _ �� � , 20 Z ?-by
� Physical Presence or Online Notarization
4f N ('ra-N r- EL.1- Z
Name of person making statement.
Personally Known j° OR Produced Identification
Type of Identification Produced
(Signature of N ry Public- State of Florida)
KONNi
Commission No. 41-�!/0 (Seal)
y Public -State of Florida
NotarCommission
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My COMM. Expires )eCbt34
p
2025
3onded through Vatiorai Notary Assn.
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