HomeMy WebLinkAboutBUILDING PERMIT APPL,4235 N HWY A1AAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 f 1 G /22
LuGUr
_.:
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
Commercial x Residential
CBDG Funding
PERMIT APPLICATION FOR:
"PROPOSED IMPROVEMENT LOCATION:
Address: D,'3 E N N W 'k.1 A 1 A r+ P i ifr6 ,t- P L r3 cl ei g y
Property Tax ID #: t. d.j ULot No.
Site Plan Name:
Block No.
Project Name: q22? 5 m iAwy Al A T-I {Pierce, Fz �4 --(yot
DETAILED DESCRIPTION OF WORK:
R CYOF hlticle 1pi kCV\ +l is Se.1r- S her; ► i,1Y�d�-riJ-i m Yet
—�
F LG- 53:5 QiO, OIJn� tvtri�� C�) e FL 10e74-- iz16
S9\-)are focicr2e `59 i5
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 _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof 4-. la Pitch
Total Sq. Ft of Construction: 5 q.15 Sq. Ft. of First Floor:
Cost of Construction: $ 17, .4 uc Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_Q(z6m lAar ayurr Vi ll . J Uw r) of S
Name: -cr( i .AA 'i
Company:
Address: L4 )V A A
City: P ; -Cr "e- State: L
Zip Code: `3(,lg q el Fax:
Phone No. S?U - 4 ci V - q S-U E-
Address: 7k & A, ; l- I c, rZ d A v-e
City: /1-4e I -S State: FL
Zip Code: 3 k7U I Fax —
Phone No ci 0-7- 74
Mail:y' �k\ U S i-) U 4\, �6-MC,� \ , Gt, fvi
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail GlI�^A;"
State or County License if C 6 1 '3 3 dXci 7 j)
iwL116e u1 %.unimenuemenx Is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: V Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
..,,,,I.L.ni F%m%.r vr% mrrruvi 11: 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 hpfnrP rnmmonrina,etnr4 . r ro.,.r�,� . ... ki—:. _r �_.__.-_ __ _
1115 ykjul IvvuUc U1 wininenLernent.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Cfo n!�
Sworn to (or affirmed) and subscribed before me of 'off
Physical Presence or Online Notarization
this 10 day of Teb . 20 22 by
Ac;1CG�� j ivI i jI�
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identifica 'on Produced
(Sign of K
I.WT u lic-State of Florida)
Commission No. I+H 0-1G,9q'} (Seal)
,��p yp4jpe, LINAMARIAGOMEZ
" * Commission # HH 076897
sF �il k
;o, Expires January 4, 2025
f�." Bonded Thru Budget Notary Services
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