HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 (n-Lzcgz Permit Number:
iO4 . _ . 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: j772j 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #: 45C)2 5L)f • 10_+5' occ • 4 Lot No,
Site Plan Name: ,, I, Block No.
Project Name: �ii(�Y lan
aeuerC
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windoowws-//Doors �Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _—Roof _�" z, Pitch
Total Sq. Ft of Constru tion: feco Sq. Ft. of First Floor:
Cost of Construction: W —CO Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name a(D-. LLOLb q
Address: VS _51 ViJ
Name: ®i2
Company:
City: �_E;?>CQL01,h State.-a—
tate:
Zip Code:,5—[` 6± Fax:
Phone No.
Address:� 5. A()/
City: Q7 r� State:
Zip Coder g52, Fax:
E-Mail:
Phone No �OZi
Fill in fee simple Title Holder on next page (if different
E-Mail CDC
from the Owner listed above)
State or County License
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 LAIN INFORMATION:
DESIGNERJENGINEER: s Not Applicable
Name:
MORTGAGE COMPANY: � Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
a
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 commencer) 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Pease consult with your Home Owners 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 attiarnev before commencine work or recordine vour Notice of Commencement.
'� 4
?
—
gnature of Owner/ Lessee%Contr ctor as Agnt for Owner -
Signature of Contractor/License Holder
STATE OF FLORIDAL l
STATE OF FLORIDA
�fL�
COUNTY OF G
COUNTY OF �-5p
Sworn to (or affirmed) and subs " ed before me of
Swor or affirmed) and subscribed before me of
Physical Prsece or _ Online Notarization
thisT day of , 202€�1 by
Physical Prey n e or,_ Online Notarization
this ay of - i �i - - —' 202Z by
Rem
Name of person making statement s • A�
Uame of person making stateme
Person y Kno n OR Produced ident' ic1 o" ~
Personal) wn OR roduced identific
•�
Type of le Lion L a •
b
Type Identi ation
f"
?
,'
Produced X o
Producedl ✓ T
mow a
''3orro
x d o
�n3�
01
(signature of 14o ry Ii -State of Florida) N 6,
(Signature of ota €e State of Florida)
G)N �'
Commission No. (Seal) A o
Commission No. (Seal)
Tom
OD "n
S
0 eD
�.
J
CD
� T
REVIEWS
FRONT
ZONING
tP.W0
PLANS
VEGETATION
SEA TURTLE
MCOUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
[SATE
COMPLETED
ev. S 2