HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZI g 22- Permit Number:
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I
IF c L' L� - Building Permit Application
Planning and Development Services
Building and Code 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: PLU M 8W G 1- J�-'C-F_Gi1Z.I L
PROPOSED IMPROVEMENT LOCATION:
Address: ZU'L3 S4iNr OuCtF_ 13LVJ (,0 f- 2-0U
Property Tax ID #: /1V3 3 - .5-0y - 0 0b - Cop - y Lot No. Z00
Site Plan Name: MFtc. M Block No.
Project Name: 61"
DETAILED DESCRIPTION OF WORK:
G�1,1-01J YS00 W,tTI ltCr4 tC. 1^/*71'"r t
I+16,47'i(L , AL-90 If" Lle- G rn IC o.t (LUni VO4OX 20 I--T OF Solt F4C,5' kdU/✓T P✓G
CUr w) r AWP K0001-' N,<w 3u,4I1 P Vougl F Pboe- SCON,✓E CT S'w trek t tvifgP
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
✓✓P
Electric lumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ O LY- 3 I Utilities: _Sewer _Septic Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name: 121Co4jz0 3el. 4F-t►15,
Name DOQCL 4.1 Mri
Address: 2013 Sr Lue-165 BLVO .# Z00
Company: ftro. fc. 4tv.0 At&
City: rf PI £2 C/5"r State: fr
Address: 10 1 S w S0 J 11-f pA4 cdo 0 Gtyo
City: Pons Sr W Ct F State: 11-
Zip Code: 3Y 9Yf- Fax:
Phone No. 7 U2 - L YS'- Qo 12 E-
Zip Code: 3 b 4 SlY Fax: 7 2 2 - 3 k0 - 3 7a z
Mail:
Phone No 777- 3-io - 37g 7
Fill in fee simple Title Holder on next page (if different
E-Mail PJ%/2M 1 T CD I°L.t r f_ I✓cFCTib rCA-N0A-rA-
State or County License
from the Owner listed above)
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
A- Not Applicable
MORTGAGE COMPANY: _,X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
X Not Applicable
UVV IvtK/ LUN I KAL I UK Al-FIDVIT: 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 attornev before commencinLy work or rPrordinor vni,r NntirP of rnmrnonromnn+
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF S',- t,ur f
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this _t_ day of f=F 82U�n7 . 20 ZZ2by
rLIC 44ao (3ag,tile_
Name of person making statement.
Personally Known )6 OR Produced Identification
Type o entification Produced
(Signature of Notary Public- State of Florida)
`��`y'�e'. KONNI LENAE DEWITT
Commission No. ���lL 3�/ (Seal)=' '° Notary Public . State of Florida
Commission HH 165134
My Comm. Expires Dec 10, 2025
3onded through vatioral Notary Assn.
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