HomeMy WebLinkAboutBuilding Permit Application�v-
All APPLICA LE IN rO9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^►
Date: 1 as Permit Number: aa61�
ST. L(JCIE
COC.I NT�Y
F L O •R I U R��
Planning and Development Services
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBD'G Funding
RECEIVED ,
Building Permit Application
St. Lucie County
Permltt+'��
Residential ✓t
PERMIT APPLICATION FOR: S
PROPOSED IMPROVEMENT LOCATION:
Address: Q It l K= Trot • h'o4 O�i tCe S Y9 VL
Property Tax ID #: i3 (ca — 7 q 1- 0003 - 000 - ` Lot No.
Site Plan Name: MULE 5 Qes idence— Block No.
Project Name: Ulf S ge-S
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 X Windows/Doors _ Pond
X Electric Plumbing _ Sprinklers _ Generator X Roof i }I I� Pitch
undu^1 q
Total Sq. Ft of Construction:
3 o� i oil i3Ygirs Ft. of First Floor: %l
Cost of Construction: $ I A d , ®O® Utilities: —sewer )( Septic Building Height: AEf -
OWNERAESSEE:
CONTRACTOR:
Name Dona u-ers
Name:
Address: 9 ? 3SW 1qbino�rAor9 RVe •
Company:
City: P!9L State: fL
Address:
City: State:
Zip Code: :9S Fax:
Phone No. 7 7a- 9-711 -Gi/;23 E-
Zip Code: Fax:
Mail: D Y7i1me f'S , t7 Ccoty-e- • S IZ:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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: I Ca -us 4tJ Name:
Address: 10 igive-, 916r, Address:
City: ori- ice- State: FL City: State:
Zip: 3glRa Phone '77—'7%5—bViu5 Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
D( Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
�CNot Applicable
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 fore commencing work or recording your Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA q, �
COUNTY OF �"� CLV
Swor to (or affir ed) and subscribed before me of �/ Physical Presence or Online Notarization
this day of 2QZ by
Name of person makings at ent.
Personally Known OR Produced Identificat'
'
Type of Id en do Pr ed
?
(Signat ota'ryPu ' - State of FI@7ida� �3 1s cr••. �_
Commission No. lt'1d U0V&eag • ���
• #HH 066456
i �• o �ye0uded
�/ 9Py•• public
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REVIEWS
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ZONING
SUPERVISOR
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SEA TURTLE
MANGROVE
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DATE
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DATE
COMPLETED
Rev 10/12/21