HomeMy WebLinkAboutBuildimg permit application - Camino Del RioAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
glr'�
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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3�% ��/J/ — by d2 �GG� Lot No.
Site Plan Name: 6?,P44e4 Block No.
Project Name: D eL sIs'Gra/g/h d
I DETAILED DESCRIPTION OF WORK:
OW. .1/ ii �. • era.. L
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: $ ,�3•3
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name "my —.a Li5lril��, � r�sd
Name: AIAM
4
.
Address: �?Phd Si 4'4-Z
Company: r
1 Jr/v�
City: �T��Gtc�j%� State:lL
Zip Code: 3�/�5� Fax:
Phone No.
Address: O
3
City: �s,9,tr
Zip Code:
Phone No
_ State: /f—Z
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail�ljF���f/�i�
State or County License
[li p/9�j'3S
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 LAVA INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: /�i9LrG ,U�w .fnrG
Name:
Address: ,549Sr-
Address:
City: State..
State:
Zip: '?.y . Phone 77d2-V
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 is in conflict with any applicable Home Owners Assoc3ation.ruies, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your [come Owners Association anc nevi -w your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I coo 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Cortorgs Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF � � E
COUNTY OF ®'J 4e,-r/1/
Swo to (or affirmea) and subscribed betore me of
5woyrt to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
e/ Physical Presence or Online Notarization
this _Z.E: day of 202Zby
this er day of f/�� Z 202�Lby
Name of person making statement.
Name of person making statement.
Personally Known r/ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ae25� )�
(Signature of Notar rdP _��
(Signaurre of Notary Public- State of
Commission os°� NiYCOM 85220
OEONEMbECK
Commission.
emb��{�022
x' o` E.)CPIR:Deceivniters
onded Thru Notary Fubt
:• SPIRES: 4ecember 18, 2Q2
VFFL�`, SOn
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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EATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.5/6/20