HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI�CAB E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �`}� IAO-2,,D, Permit Number:
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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1509 N60 WX77 S CAEFk' f i> PigCI CITY F.L, . NCIC10
Property Tax ID #: q'44 6. - 'Ms_ G Lot No.
Site Plan Name: Block No. G-ha
Project Name: -/p fil1E� C► � `
DETAILED DESCRIPTION OF WORK:
"PANF1 1--IJ M64 0cl r " ail/ 4/0
'G
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
? Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ pc�y • Op
Gas Piping
— Sprinklers
(Affidavit required)
_ Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C1YAR(-65 T. W #17z
Name: MTH M
EI66L#)�W4)
Address: %--/Oq A(td . GJ1AJW5 CPZW leo
Company: ACLU RATF
UtCTCi'CAL COtiT,
City: pRe-'1 C(r`/ State:f-
Zip Code: Jggqd Fax: - d
Phone No. E-
Address: !3Q AM ST-4k.'kWJSTNLU,64W
City: SL
Zip Code: 3 49,� G
Phone No
State: ik
Fax: Qj
Mail: (:17(4V!!)E00 � TFf•l�lEj~'
-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ACcu&A1 e-,ELE(TFIC f}5C Q�7"LrAL, �biy1
State or County License EC00030 );z
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
Name:
Address:
City: State:
Zi p: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated_
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 our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COLINTY OF —WA, T Z.uC/,E
Sworng (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of hehttjofL 207-2 by
Name of person making tatement.
Personally Known OR Produced Identification
Type f Identification Produced
(Si ature of Notary - State of Flori
i��.Y�•' JESSICASANCHEZ
Commission No. H11 DWN5 (Seal) ,: Commiss'san#HH081950
= ; : f Expires January 19, 2425
�'Fo. Fi°•' Eawad 7hra Troy Fain Mumma 0085.70%
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21