HomeMy WebLinkAboutBuilding Permit ApplicatiomAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �`a.a''�� Permit Number: _ Ra
O
°0 °' " 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: l.) -e,
PROPOSED IMPROVEMENT LOCATION:
RECEIVED
FEB 2 8 2022
St.,Lucie Co ry
Perrni B
Address: s :7 5�6 A,11�1 <4 , �L /-ZX ,ie-14T&62f
Property Tax ID #: a`.5 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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
_ Electric _ Plumbing _ Sprinklers /Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Windows/Doors _ Pond
_ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1'01, -t
[qWe Z
Name:
Address: ;Z 7 rG S ���5 ���
Company: •� ��/�� a ���
.�i L
City: ReL,, i' State: fl
Zip Code: 3Yf1YC Fax:
Phone No. "7 7,;2 ` &-7 E-
Address: 7S'6 s�
?
City: Ab A&zel;-01
Zip Code:
Phone No `7'7,2
Fax:
State:
Mail: c.) gRLA (y C- Z. ►/ aV e %Z✓N
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail />'�i4L/ri 0
State or County License
e�yrJ
egC" e'-wy
iQO(. ++*1
I f-72-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN 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:
City:
Zip: Phone:
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 commencine work or recordine vour Notice of Commencement.
f ,
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORJPA
�
I�iA.C�
COUNTY OF � t_:�-
Sworn t (or aff �) and subscribed before me of Physical Presence or Online Notarization
this ay of l t 2Q=�by
Name of person making statement. '
Personally Known v OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal) ��y � in 11111
0101,01 aw W*i 'WWn FN
M ,
"AhN4Ri4W %
319) bV11
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 10/12/21