HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development Services
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:
PROPOSED IMPROVEMENT LOCATION:
Address: �Qt�i _E_-S(Gr-'z ef 7 `77- Eaiz'l `PiC2S=
Property Tax ID #: Z3 "Z.(o " (,=Q0 — e Q �--i lo' CS00 — 3 Lot No. � 9
Site Plan Name:
Project Name: Agt�518U,_.—
DETAILED DESCRIPTION OF WORK:
Block No.
Itjsin U_ i 9 s- ° ace cq` T^c,L L^cv- .1,a ki a &ik � Px tAi r zLq
W / OF C-1'g
New Electrical Meter
Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION: j
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank —Gas Piping _ 5hutters _ windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
0
Total Sq. Ft of Construction: I `fit Sq. Ft. of First Floor:
Cost of Construction: $ (05`1.0 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Aswlil �S.4
Name:
Address: S`17-i C-o`36L. 0PiF'DV--
Company: F�eJe ls�i �-��--
City: v�j ni t6<2-C(5_ _ State:
Zip Code: Sgfjq'�;- Fax:
Phone No. 2i'2 , (®i C®- oGG N E-
Address: '7"7443 5L._> 13ucy=i.4 n4W rl
City:`Pi,2Sy��� ' State: C-t
Zip Code: ''49 ��-3 Fax:
Phone No
Mail: ASS AlA( iE, l� cClv��t`o c; Li�� 2� •��
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C a., of 12 6 1' i* 4-- 6 an's
State or County License
IIf value of construction is 2500 or more, a KELUKUW noTice or commencement is requneu.
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: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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 our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicabT&�_
STATE OF FLORIDA
COUNTY OF S�T LuC cE�
Sworn to (or affirmed) and subscribed before me of a Physical Presence or Online Notarization
this ! C_ day of e_)20Z2 by
Name of person making stat ent.
Persona y n wn OR Pro ed Identification
Type of e ifi ti Produc d
(Si nagWe of Notary Public- State of Flon-Cal
ommission No. R14 Z-2-I 61'a (Seal) otary Public State of Florida '
Danielle Hammerstone
AN
My Commission
HH 221098
EXp. 1/26/2026
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Rev10/12/21