HomeMy WebLinkAboutBuilding permit app 2 doors, 3 4, 2022 541All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
^ • Permit Number: Date: '^jlj^^Q^^
Planning and Development Services
Building and Code Regulation Division _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Building Permit Application
Comnaercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Sfxi^rfNC j^PCP^d
Property Tax ID #: \30 J- Q - (7 \ ^ ~ Q (00 ^ ^
Site Plan Name: k A %c^r\
Lot No.
Project Name: O ^n)i\f\Sr'K\
Block No. \ ^
DETAILED DESCRIPTION OF WORK:
Qf'o\(Xr)(\n^ -fiv)f\-t- Antnr CKr\c\W ArsnC \_.}^^-Vs
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: Sq. Ft. of First Floor:
Utilities: Sewer Septic
Windows/Doors Pond
Roof Pitch
Cost of Construction: $ "7 Building Height:
OWNER/LESSEE:
Name g.£)b>':f^ :r<okt\Sr)A
Address: 7 | r> Sfilf rp>Cl ^(7r/<4
City: V^nr-V P.'f?^r(=' state: £L
Zip Code: ^ :r \: ^{g^- S~^l0
Phone No. y (Xi 3r^^~ ^ .
Mail:
E-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: f^n)f\
Company: (Ip-H- H^mf ^(^(>^f;V. >C h\<C
Address: (^c?<r 9 \ f
City: tjc^rn t^»^(>.eK State:
Zip Code: . Fax: Sjfi^'SJi ? Q
Phone No - 5rt/' '> ^ iC ^
E-Mail r>^•^Y ^J^<Y^^ ^-H-> c ^rr\
state or County License ri^C \^S'Q '^'j
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 LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name;
MORTGAGE COMPANY: Not Applicable
Name;
Address: Address;
City: State: City: state;
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: Address;
City: Citv;
Zip: Phone: Zip; Phone;
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worl< 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 attorney before commencing work or recording your Notjce of Commencement. _
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA, ^
COUNTY of_JndamJaMil
Sworn to (or affirmed) and subscribed before me of _
this day of jsQg^y^ , 20^bv
Name of person making statement.
. Physical Presence or Online Notarization
Personally Known OR Produced Identification
Type of Identification Produced
(Signajf*e of Notary Public- State of Florida)
Commission No. C^S^ 2/^44^ I (5e,
Rev 5/20/21