HomeMy WebLinkAboutBuilding Permit App - Wikel All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 e .12 Permit Number:
L: C_11JI
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:
MEM
Address: S500 ST. LYCIE 61,y0. rLor Z.
Property Tax ID#: 17 ts 3L1 33 A 000z- 000 -Ls- Lot No.
Site Plan Name: Block No.
Project Name:
EMENEE
RAISED l,JpoD PC�Ck., Amp IgSrA" 2-tuALL
ScK-EEN Rood Aub 3-WAu UT1Lrri ,SI�_�" PoLY-iaSu LATE D Rood
New Electrical Meter Second Electrical Meter (Affidavit required)
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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��j i SOQ Utilities: —Sewer —Septic Building Height:
Name C'AIZOL WlteL Name: CMAALES T. DEIdk4LIL.
Address: 15oo S7 LucIE BLVO. _ T-19 Company: "Sr COA-TT ,ALur+ InruM
City: F`r M Etc a State:_E Address: 0113 FDWAROS AR,
Zip Code: 3N9 L/4 Fax: City: FT. PIEIi'CE State:FL
Phone No. 93LI, 32 2,D80 S E- Zip Code: Vff*'Z Fax: 7?Z- 4104-7CV3
Mail: Phone No '772-q 64-76 C V
Fill in fee simple Title Holder on next page(if different E-Mail eca p i vi c 0 A a lm a t I'. G o►n
from the Owner listed above) State or County License 5 0028 Y-06
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Fao2.tpA AtaMsArua" C-ovizzy IetNG Name:
Address: S6w MARikE!C S7 -92No Address:
City: -rAIn?A State: FL City: State:
Zip: 3 6o 9 Phone J013-3 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: A0AV Itutimee n2ArveL l2eSoR.r Name:
Address: S50o ST. LuciE F3wo, Address:
City:fT, IP►ERCF_ City:
Zip: 3 y 9 yG Phone: 7'7-Z- L/,g H- p 96 9 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 lende0oran att o e commencing work or recording our Notice of Commencement.
Sig r of C ac r-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF St Lit a tE
Sworn to(or affirmed)and subscribed before me of tlhysical Presence or Online Notarization
this/4PL day of fE6 tzW^yLY 2072-by
C 4 A Pc Les J. p E y-e1L
Name of person making staterpent.
Personally Known OR Produced Identification
Type of Identification Produced
-
%�+�--
(Signaturev of Notary Public-State of Florida)
RUTH HOLMAN
Commission.No. &C-9 73G4a (Seal) c� t� 4 NOTARY PUBLIC
o It STATE OF FLORIDA
y ?Comm#GG973640
iN 10 Expires 3/26/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v10/12/21