HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �S
Date: Z / C, / 2 Z- Permit Number:
-U llo
0,
Building Permit Application
Planning and Development Services
iZECEIVED
FEB 10 I'll
Permitting DeparYn,ent
St. Luue Co "•.,
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: 66(- �e oo
PROPOSED IMPROVEMENT LOCATION;
Address: S 7 W- H i 6 C)e-nl A n es R J)
Property Tax ID #: c23 a 3 - 701- OCR 13 -000 - Lot No. 13
Site Plan Name: Block No. _A
Project Name:
DETAILED DESCRIPTION OF WORK:
1� er, lace. e i -F l e xi
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: $ 1 /$00.00
_ Gas Piping
_ Sprinklers
(Affidavit required)
Shutters _ Windows/Doors _ Pond
_ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name UAN M v F Me- 0 h,,CA
Name: . sae- &r l y
Company: - 1 cc-h 61c, rcuq P boor S
Address: 912) dLe&, h; M Q_s 12►3
City: Et pl crc_2_ State: _
Address: y$6�Z /VW !U+'Yacr A 1310 J
Zip Code: 3 ` C1 N S Fax:
City: P, S. L. State:
Phone No. ( 1< - 6,7 Y E-
Zip Code: 3L/44A3 Fax:
Mail:
Phone No ?? 2- SZ$ 5 y Z k
Fill in fee simple Title Holder on next page (if different
E-Mail 6? C eviW- Ao
from the Owner listed above)
State or County License 2 $ 3 (,- S
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 -LIENz LAW INFORMATION; -
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 attornev before commencing work or recording vour Notice of Commencement.
S' nature 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
C' day of _ this Ao 201?_by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced Z)C'
(Signature of Notary Public- State of FI i a
wu„o.
Commission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
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DATE
COMPLETED
Rev 10/12/21