HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
69ao3 G L/50�>
0 RECEIVED
r�
° '"` Building Permit Application MAR 15 2
2
Planning and Development Services
St. uol
Building and Code Regulation Division Commercial Residentiermltt� 4'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 'r� E a% 3 f v
Property Tax ID#: f'Ad I - (. 62 -�b 3ad-- ba�1-3
Site Plan Name: � c c, , �T -7
Project Name:
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
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ t 3 0 UU
Sq. Ft. of First Floor:
Lot No. a -.?—
Block No. 71
Window /D0000rrs _ Pond
e�
oof cll/
/- "tch
Utilities: _ Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name :3-- a o Q t, —
Name:y� (Z
_r,
V
Address: ? �l �n a•.x, G`. 11os
Company. 1'
City: Lug t �Lo 1 r� State:
Address: %Q a G �' ,�c�3
�32. MIA
Zip Code: 3 L4 c?�� Fax:
City: �2 m� J.�
State/
Phone No. E-
Zip Code:34R
Fax: qG9--ZSZ-7 Z
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License O.CC
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 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 unty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
lerYder or an attorney before commencing work or recording our Notice of Commencement.
Op-
e o Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF SdL I
Sworn to affirmed) and subscribed before me of
this day 20'nl;y--
ysical Presence or Online Notarization
of
Name of person making st�Prod,lcpd
Personally Known ntification
Type of Identification Produced
(Signature o otary Public- State Florida)
Commission No. (Seal)
sealdx uois91wwoz) AyN
Meli HH # uoisslWw00
MJOIJ ;o e3e1S- !Iqnd AieloN i=
GuOdune 83H.LV3H�'%%;,',;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21