HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE C ., PLETED FOR APPLICATION TO BE ACCEPTED
Date: f Permit Number: DQ w ��
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-Building Permit Application
Planning and Development Services
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
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PERMIT APPLICATION FOR:
PROPOSED`I'MPROVEME��'NT LOCATION:
Address: 3 f 5 ! s��� or T �ce►�'G+!i yf`�►
Pr opertyTaxlD#: �� rIJ�'6c7��' DOO��
Lot No.
Site Plan Name: 5t_C M�IC��x--�"'C o �\ ��S'�rc�'�' Block No.
Priject Name: f CAP S L.Z--O
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DETAILED DESCRIPTI0N`OF~WORK
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al Arim",
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New Electrical Meter 1 ; Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFORPg ION
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Talnk —Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
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Total Sq. Ft of Construction: i + Sq. Ft.of First Floor:
Cost of Construction:-$ V. I()J c> Utilities: _Sewer _Septic Building Height:
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OWNER/LESSEE CO:NTRACTO r
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Name Lr.-Gt e. Cow Name:
Address: 07 06 Company: �j I�iflr�125 Ce^&+ -,TV�L
city: State:F L Address: PO 7ma2-4— 7$SJ
Zip Code:d?" `�9'72 Fax:, City:�r��L� State:-EI-I
Phone No. I. E- Zip Code: Fax:�.TYxst J;ff��o
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Mail:_ )77Ast—e rX c_ C.o d52!`j Phone No n el`L 7 L(o Sg-t-8 A�14A kC;C
Fill in fee simple Title Holder on next page(if different E-Mail kz c%T-C-t?S(e@ c NAea& Co-\
fri m the Owner listed above) State or County Licens<(-.LC
If value of construction is 2500 orlmore,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or moral a RECORDED Notice of Commencement is required.
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SlrlP'PLEMENTAICONSTR' �CTlON'L'iE,N LAW�INFORMATlON4 'mot ..Y �
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DESIGNER/ENGINEER: ! I Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: �'' Name:
Address: &L c;-Q Address:
City I ! State:,LL City: State:
Zip: 7 Phone 'I-le Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: �:! Name:
Address: I ! Address:
City: I i City:
Zip: Phone: f I Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation�'has commenced prior to the issuance of a permit.
St.[ucie 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 tih'is 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 attorne' !before commencing work or recording our Notice of Commencement.
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SA gnature of Contractor- r-Owh6r Builder as applicable
STATE OF FLORIDA 1;
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of �OrQ_�I ,201?.by .A f
Name of person making statement. i
Personally Known OR Produced Identification
Type of Identifica ' n Produced
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(Sign Nota blic " of F o da) � ;P�. FAYE FITZPATRICK
Notary PublWStsts of Florida
Commission No. (Seal) a Commission iGG368668
i��fOF FAO My Commission Expires
'7JI11��`� August 24,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
'DATE
RECEIVED
DATE
COMPLETED
ev 10/12/21
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