HomeMy WebLinkAboutBuilding permit app 1 24, 2022499All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: Date: | | ^ V ^ ^t?^^
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
Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: [)f\p.nf\
Property Tax ID #: \^ Q ij> \''j ' Q ^ fP j - Q OO '
Site Plan Name:
Project Name: _
Lot No. i S~
Block No. /
DETAILED DESCRIPTION OF WORK:
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ X. Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
Nameflohfrar kgyif-kl ff^P^ _PI?CA.9 11° T
Address: ^ ni BbJL^XMjjC
City: For-f P;^rre State: £i
Zip Code: ^t-ZC} ^| Fax:
Phone No.^.7ci- 7VQ) - S\SO E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: \^ij]r- (^fi-K-
company:j^,ort (^•Qf-f- ^on\t, X/nf'^U • wB/r
Address: 6? Pl C\r^
City: Vi^t-T) B<^^A/-K State:
Zip Code: ^ (f,^ Fax: ^-j/y - To^,<7 Q
Phone No -^^^ -.V^/^- ^ V ftf^
E-Mail ^(^rA.^y (ViJN ^ a^}r^rcrH, < 0(V\
State or County License \ P^'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.
1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
1 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:
i City: Citv:
1 Zip: Phone: Zip: Phone:
1 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 alt 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 Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA ^.
COUNTY OF \r)C^ffX^ VA^IW
Sworn to (or affirmed) and subscribed before me of
thisday of ::y-cn^o.K)c\r^j . 20^by
. Physical Presence or Online Notarization
Name of person making statement.
Personally Known _ OR Produced Identification
Type of Identification Produced
(SignalfS-e of Not#v Public- State of Florida)
Commission No. QSK 2^^^ 1 (Se
REVIEWS
DATE
RECEIVED
Notary Public Statt of Flori<l« Jennifer MRidTjTjond
My CommlMlon GG 204491 Expi™« 06/21/2023
FRONT
COUNTER
i ZONING
: REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETED (lev 5/20/21