HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABI. • 1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r� ^
Date: G� Q Permit Number: �cY ' Q&
Application
and Development Services Building Permit A '
Building and Code Regulation Division Commercial Residential
2300 V/rglnla Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: LC C-rR ICA L
Rt1OPOSEMIMPROVENfENT;LOEAT dN:
:.
Address: 5 �- � � U► N 1I iZ n 1:T 19I � exr r
Property Tax ID #: Lot No. I1$ 19
Site Plan Name: _ �w��'1 i-iP , ('�, a� Block No.
Project Name:
�
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTfON=1NFORMATIOIU':
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: $ --A, a14 60 Utilities: _ Sewer _ Septic Building Height:
kONTRACTp
Name 0J
Address:
City: R . pleft P State: F
Zip Code: 31Iq$ I Fax:
Phone No. lo3
E-Mail:SGN)(plPV fpbei-4 -ian° (Yti" ,rai•
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:J ANt5 tr . MATUL.Pr
ComparI"LPG E ECT1 tAL CUNTl1Z1hQMZ
Address:_1010 W VAIibWM �.
City: FT. -1 igC 5 State: FL -
Zip Code: 3Lig811, Fax:
Phone No 'lu-4�(n)- 83-a$
E-Mail _iQ�Sm iulead-
State or County License E u?) oa3
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.
PLEMEN1' l.~CONS* RUCTION LIERI I.AUV 'N:F®RI
IATI®N.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not 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 or an attorney before commencing work or recording vour Notice of Commencement.
Signat a Owner/ Lessee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF a. 2
Sworn to (or affirmed) and subscribed before me of V/
Physical Presence or Online Notarization
this _& day of eblrCl('aY'\I 20a�a by
•3AME5 C MaTuLA
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification Produced
,► a_ -">�
(Signature bf Notary Public- State of Florida )
Commission No. 5 a Oclo1 :o.V" lk Notary Public State of Florida
(seal) Margaret E Montepare
My Commission GG 214990
yId 'Expires 06/0512022
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Kev5120/21