HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ 13411 - � � Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOC/A�TION/:-� /
Address: dQ �l Se C. t'O f Lac
Property Tax ID#: .�71� "OD�-�D,z �•aQ0
Lot No.
Site plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
W for Wi ke-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Block No.
r hecc]�er
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: $ J z oo,
00
OWN ER/LESSEE:
Name ell' OGf S
AddressLA /.3 15 /( f.
(Affidavit required)
_ Gas Piping Shutters ^ Windows/Doors _ Pond
_ Sprinklers — Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
City: I & L 1 , State: Aly
Zip Code: � Fax:
Phone No. 667 701-kY,? E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: f .y e f b
Company: 0r i �lCf e �(
Address: A eri r
City: Sf Lucie- State: F4
Zip Code: 3q15'� Fax:
Phone No 77a g68-65a q
E-Mail l' U.Cie Ufi6 i rig
State or County License
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
UW1YLHI L:UN FRACTUR 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 commencina work or recordinn, vour Notice of Commencement
Signat r f er/ Les a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF 5�- Lwie.
Sworn to (or affirmed) and subscribed before me of
thisday of z�fGh 20ZZby
Physical Presence or Online Notarization
r Zaele
Name of p rson making statement.
Personally Known Y OR Produced Identification
Type of Identification Produced
(Signature of Notary P ic- State of Florida)
Commission No.�6.3 65� {Seal} _
Gomm.1038 858
20
g��'���►.i+ri
�:� NOW
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
e.,