HomeMy WebLinkAboutBuildling permit app, 3 4, 2022548All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: //^jV/aP^P? •s, Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: <rV <9 | V) ^ O r\
Property Tax ID #: R nl - I ^ - 0^0^- O 00~:^
Site Plan Name:
Project Name:
Lot No. / S"
Block No. ) U >
DETAILED DESCRIPTION OF WORK: liZZ
• " (Affidavit required) New Electrical Meter Second Electrical Meter
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:
Cost of Construction: $"1^ <j ^ 3— Utilities: Sewer Septic
Windows/Doors Pond
Roof Pitch
Building Height:
OWNER/LESSEE:
Namejg^^gry >^\Zj^\AL:Lrsl_^i^) \ ^
Address: STH 0 \
Citv: F(OH- P)fK-Ce State: FL
Zip Code: .^V^^y Fax:
PhoneHo._::nAr:^H^ -%\i^o
Mail:__
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-
CONTRACTOR:
Name: JCevJLl/v_jg.ai±
Companv:"Y^m d&t^r \^t<\e l^fyfr^U. ^sl^/c
Address: (fi^^ ^\r,^rf
City: \JerV 0>C£iCK State:
Zip Code: J^J^OJ Fax: <rZ^> - t 0..
Phone No ^6?">- 1 V O ^
E-Mail rv\^ry fty;ff^ fc^J rr.rcH-. rcg^A
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address: Address:
Citv: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: Address;
Citv: Citv:
Zip: Phone: 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 attorney before commencing work or recording your Notice of Commencement.
Signature of Q»/ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA,
COUNTY OF \ndil[lM\
to (or affirmed) and subscribed before m
% day of :S'a,r>U^^y . 20^bv
. Physical Presence or _ Online Notarization
Name of person making statement.
Personally Known \__ OR Produced Identification ,
Type of Identification Produced_
{Stgna|(*e of Notdfy Public- State of Florida)
Commission No, QSK 2^44^ \e