HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - REVISEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
J�o LU ')UL ..
c E C_ 11. c E Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: C(„n�Ucior\ 0.�0, new Sirn'je-Rasrv\ife5�3erce-.
PROPOSED IMPROVEMENT LOCATION:
Address: 10 10t 5 O�,tan DX -#1=-(pJQ� k� 5f0Gh FL- 3LR57
Property Tax ID #: �-{SI I -�OJ`— - DO - Q(,U -� Lot No. 3
Site Plan Name: ��'r��(e 1t-
Project Name: �0rG(il
I GETAiLED —DESCRIPTION OF WORK:
C.Or1
New Electrical Meter
_o a Inevd Siwi 4
2-
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Block No,
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters r/ Windows/Doors _ Pond
-Vtlectric lumbing _ Sprinklers _ Generator oof Pitch
Total Sq. Ft of Construction: ff(d--t Sq. Ft. of First Floor: i s5s
Cost of Construction: $ 54010M . c c Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S
f 1
Name:
5
Address: I0725S 0�-eQn (Y. 1� 257
City: 3--n-sp—n ReCLCh State: F_L-
Zip Code: 3L1q)'7 Fax:
Phone No. 515 --710- LJ-7q(a E-
Company:
Address: - DAve-
City: `ALXXH_ State: —
Zip Code: 3oAC(gLA Fax:
Phone No 7-72-- 2 -9-` 439
Mail: 056icradt Q uuin st eom . fle_-�-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail macy.(iMel - Q'I - Com
State or County License �Gcosq LA 1 2.
It 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:
Name:
Address:
City:
Zip: Phoi
FEE SIMPLE TITL OLDE
Name:
Address:
City:
Zip: Phone:
_ No; Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
UwNtK/ LLIN I KAL I UR 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 attornev before commencing wnrk or rPrnrdinR x/mir Nnfira of inmmcnromont
Signature of Cqn ractor -'or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thisn�Oday of 20 22-by
AA
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Sigfat re of Notary Public- State of Florida .
"•`` i HLEEN GANNON
Commission NoPC:5JL NDO (Seal MY,;'0viMISSION#GG914cep
cXPiRES: January 18,
1_-_'dThruNotary PubSct.-Arxrtdrs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21