HomeMy WebLinkAboutBuilding Permit Application All APPLICeAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: o� -3 Z, Permit Number: O�� 1
Ff" PUSNY
. RECEIVED 5 Building Permit Application
Planning and Development Services FEB 0 2
Building and Code Regulation Division Commercial Residential Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: 0U _ w�d
PROPOSED IMPROVEMENT LOCATION: J
I
Address: S
Property Tax ID#: ' ,�Q J 00 -" D 00�2 41_-O)n— Lot No.
Site Plan Name: Block No.
Project Name:
i
DETAILED DESCR PTION OF ORK:
A/oo �/a j
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION I:NFORMATIO.N: j
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters Wi�0�?. ""
_Pond
Electric _Plumbing _Sprinklers _Generator _Roo �a Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 7 Ur �—
Cost of Construction:$ T�i d Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:.. CONTRACTOR:
Name Gi Name: S orlelteei-
Address: C' Wv' , Company:
City: o_'ea� State:%Jam' - Address: Lo 5113
Zip C e: 3 vS Fax: City: State:
Phone No. E- Zip Code: Fax:
Mail: Qc�O�Jb►� 1►►1Q`kQ� Phone No
Fill in fee simple Title Holder on next page(if different E-Mail C,' tiZ I n e (9 r0 tl S. (f 7'—'
from the Owner listed above) State or County License WC I ✓�3�SCE
If value of construction is 2500 or more,a RECORDED Notice of Commencement is requilred.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Appl' le TGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Zip: Phone:
FEE SIMKEFTITLE HOLDER: _Not pplicable BOND NG COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: P ne: Zip: e:
116 91
OWNER/CONTRA OR AFFIDVIT:Application is hereby madex obtain a permit to do the work and installation as indicated.
I certify that no work o installation has commenced prior to the issuance of a permit.
St.Lucie County make 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 plicable
STATE OF FLORI4 _
COUNTY OF-- c�5-- - b y C4 te:2
Sworn/to(or affirmed an subscribed b e e of Lical Presence or Online Notarization
this day of
Name of person making statement.
Personally Known OR Produced Identification
Type tification Produced
(Signature of Notary d, i tag qM' Ibl�IISSION#HH218597
Commission No. I..,..Q Seale ��20,�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 10 2 21