HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .3 �� Permit Number:
F V
0LL Building Permit Application MAR 0 i 2
2
Planning and Development Services
ST. Lucie Co ty, Permitting
Building and Code Regulation Division Commercial Res iden la ---
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:-LOa 1 g ay)rarnd'a 1)ir \Be_ Ti0+--�-Pye,yrce s R
PropertyTaxlD#: Lot No. r
Site Plan Name: Block No.
Project Name:' 9� �
DETAILED DESCRIPTION OF WORK:
'�. r ,
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 _PPond
Electric _Plumbing _Sprinklers _Generator a, Roof p!ttcch
Total Sq. Ft of Construction: f-4- Sq. Ft.of First Floor:
Cost of Construction: �`] Utilities: _Sewer _Septic Building Height:
OWN.ERR LESSEE: CONTRACTOR:
Name Name: rim e0u..`—
Address:(aW 7 Company: Cal-
City: Q,��t� State: Address: M
Zip Code: Gy �i'� Fax: City: State: ��
Phone No. E- Zip Code: 3kA.CA Fax:
Mail: Phone No '7-1Z W-,1 �9_9 to-3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License CJA_�P \t_ze_
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 MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
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 failu'r�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 our Notice of Commencement.
Signature of ner/Lessee/(fontra , or as Agent for Owner
STATE OF FLORI � `` �
COUNTY OF��r- 1. ��e
Sworn to(or affirmed and __:Z� sical Presence or Online Notarization
� p�) `��subscribed before me of PhY
this day of li`j�1C1 202Zby
qvn )J� �Ay-\t4(a it we,
Name of person making sta ment..
ZPersonKnown OR Produced Identification
ntification Produced
F.
of Notary Pu lic-State of Florida)
11 Commission No �� � Seal) ,`"YA''• DENISE E. SUAREZ-PAGAN
�s �;.
e° `:Notary Public-State of Florida
C6mmission#HH 218518
.9 MY commission ExpiresFL���`
''HIDE`` October 13,2024
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