HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c�TI C9,;t Permit Number:
C;Z1 LLLLL,
'LBuilding Permit Application
Planning and Development Services
Building and Lode Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: y)w6 kirk\cad
PROPOSED IMPROVEMENT LOCATION:
Address: U \ 1 V11k\\oi
Property Tax ID #: _')t-t 5 1 n - O 1 57 ";L O C� - n Lot No. 11
Site Plan Name: Block No. 1(9
Project Name:
DETAILED DESCRIPTION OF WORK:
Vlco -l3J Wh\t� jC_r n clnn3 r -
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:h
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: u 1(Q
Cost of Construction: $ k , (-1-12.. a 0
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _-)Cwyt(-A
Name: Pa( -Li ILL11c�12k
Address: LAl \ \A11 \ \ c3c A LC
Nve
Company:
City: ( nr--F S-t. LI3CiP_ State:�l
Zip Code: 'SLAgS2 Fax:
Phone No.(5ca1) ")52 - C<5(DL4 E-
Address:�Zi 0 GIiV imbin v-C'_IP
City: J. )e-s-1 47a ryn -Be racl-\ State: IPL_
Zip Code: 33c 1 6-1 Fax:(S(n1'),gLir 227Cp
Phone No ( SCQ 11 R-i LA -Ca %L-IS
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailV/ 1110 a u lcaak. drfnY ,mat, ,
State or County License (a - 1 R I (0 3
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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 attarnev before commencing work or recording your Notice of Commencement.
114
Signature of con ctor - or- Owner Builder as applicable
STATE OF FL RIDA
COUNTY OF V(.t�m
Sworn to (or affirmed) and subscribed before me of
Physical Presence
or _ Online Notarization
this _2__ day of lrt koxtA 2022 by
U 1 IL J
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
( nature of ry Pu - ate of Florida)
Commission NO.CYG / g9c565 (Seal)
PEYTON E FINLAYSON
commission # GG 199505
Expires March 22, 2022
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Rev 10/12/21