HomeMy WebLinkAboutBuilding Permit ApplicationR� ER1CY
All APPLICA LE IJYF0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1� `�
Date: Permit Number: _,yaoa ort17 7
L�l LI?
Lr c- %2?? L =1; c, Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Vlrglnia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORA--Ci
RROPQ5ED-IMP-A0VEMl5NT.I OCAT4QN:
Address: - i C� a-- FL EF—TWCoD ly IeKck�_
Property Tax ID #: Lot No. +i
Site Plan Name: _ _"21 �-�Qp ,� ��N 012 Block No.
Project Name:
DETAILED -DESCRIPTION OF W*}RK
YL
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
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction: $ ��� �� Utilities: _ Sewer _ Septic Building Height:
:OWNER/L'ES5EE"
.,.,<
Name L-\ISO I�-il,11..14
Name:
Address: 11(3a- Company: M�TUU°t ��L�.CTIZIC14l.
City: Ptle+20- State:E -- Address: 'ICE I b 1, P 1 6 LL) k-1 e b
Zip Code: 3 q$ a-- Fax: City: F—T► P(t2z.jC-�--' State: P
Phone No. Zip Code: 3 4ctgti Fax:
E-Mail: Phone No 'lam— yLol—�301�
Fill in fee simple Title Holder on next page*( if different E-Mail_�MJrndM (Yna.+LA 10�� qpi. (0yh
from the Owner listed above) State or County License I✓,Q. 13(501(OL43
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 C0f�5,IFIRUCTION LIEN LAW INFORMATION: �
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 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 your Notice of Commencement.
Signature o tractor - or -Owner Builder& applicable
STATE OF FLORIDA
COUNTY OF S}.
Sworn to (or affirmed) and subscribed before me of
this ID day of �b . 20.')k by
Physical Presence or Online Notarization
J:, MSS -�= . H P�TU L f
ent.
Name of person making sta®Produced
Personally Known Identification
Type of Identification Produced
-fY10A.a D 8. a�
(Signature of 4&ary Public- State of Florida)
Commission No. GCS o��y�9�eal)
4VY Pus 40 4Notary Public State of Florida
:° MargaretEMontepare
My Commission GG 214990
Expires 09I0512022
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Rev 10/12/21