HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. ✓•( /V�
Budding Permit Application MAR 1 2022
Planning and Development Services
cie CN
Building and Code Regulation Division Commercial Residen`fi
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Property Tax ID #: 4 3 d % - 11 1 - 0 ®01 - O 0 i0 0 Lot No.
Site Plan Name: 4 f 1-4 k-e f, 0 ceps Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION t�fFCiRMATION
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: 12 Sq. Ft of First Floor:
Cost of Construction: $ f 3 by • D O Utilities: _Sewer _Septic Building Height:_
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UWNER1LESSEE �5. f SisF� T �rlr1ki f J rdY d a! tCONTRACTO
Name ��ar(es dame: C "des '-AT rick ke, T�
Address: _!20'50 kV 5' Company:br sa��►i-
city: l0ke a drab e- State: FL Address: Z'30 50 IV E 5 fh 4-e,-/'
ZipCode: 3g61 J Z Fax• 40- 16 3 - 5 31-1 City: Q k r c �nol0�t c State: F�—
- Zi Code: -t 2 Fax: $b3 7 4a 3 S3°I'7
Phone No.----( � 2 - 3 7 � - �. � 21. E Zip
Code:
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Fill in fee simple Title Holder on next page (if different E,'Qllail �(` �c (Ce: 100 (0 YAW do. CDs"
from the Owner listed above) 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.
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pplicable
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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St Luse County makes no representation that isgra=tingg a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable HomeownersAssodaiion rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please consult wdh 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 1 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, Wails, 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
u.ith rnnrinr r,r nn n+tnmav hafnra rnmmanrina uunrk nr rPrnrdinE vnur Notice of Commencement.
Signature of Contra r -or - Owner u- der as applicable
STATE OF FLORID
COUNTY OF S Lu C.c1t
Sworn to (or affirmed) and subscfibed before me of Physical Presence or Online Notarization
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this �a"''day of � C Iti . 20 �.by G ha l�S �D rY K-0 ► , Sr
Name of person making statement -
Personally Known OR Produced Identification
Type of Identification Produced �- L
(Signature of Notary Public- State of Florida)
TAWANDA PINKSTON•CASTRO
Commission No. Ua (Seal)Notary
Public - State of Florida
Commission.1
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wc':' HH 127099
My Comm. Expires May 5. 2025
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