HomeMy WebLinkAboutBUILDING PERMIT APPLICATION", -eIC
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Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
0 P-ti,3
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
M
Lot No. I I
Block No.
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 A---R'oof
Pitch
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: $ Zt15A 1 11 aX Utilities: _Sewer —Septic
OWNER/LESSEE:
Name(,)n0,_Je0` -
Address: W-0 Q C-e r�'2 Cry
City: C-r`C,-0— State: _
RL-
Zip Code. _��{ Cj �_ Fax:
Phone No.-, `7 - ! - E
Mail.' 1 CA c., Q u3 rn co
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Developmentservices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding_
PROPOSED IMPROVEMENT LOCATION:
Address: (-9 ( c. Cz _� C,
w
CONTRACTOR:
Building Height:
Name: ;''�S 1, ,"`�1nl--fir
Company: Lsl'�r) o e, c c-
Address: s,,�s �, o,� JAU. A
City: ro P i rc-4 ...s
State: �L.--
Zip Code: -s Fax:
Phone No
E-Mail 1n E C,ws 12, iZS
State or County License C cc 1 -�3I�J
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 Applicab�
Name: o
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPA�,NIf
Name:
Address: i
City:`
Zip: /� Phone:
--,,-Aot App,lit'able
State:
Not Applicable
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 attnrnav hafrwa
wur lc or recording our Notice of Commencement.—
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of '-t
-_ 20.A�y
Name of person making statement.
Personally Known OR Produced Identification
Type of Ide ' ication Produc
e If_✓mot K.-yvf
(Signature of Notary Public- State of Florida)
Commission No. 774Z� Seal
..
�' 11k Notary Public State of Florida
Caron M Quinones
y c. • My Commission HH 093277
~fora Expires02/15/2025
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
VEGETATION
SEA TURTLE
MANGROVE
DATE
REVIEW
REVIEW
REVIEW
REVIEW
RECEIVED
DATE
COMPLETED
Rev 10/12/21