HomeMy WebLinkAboutBuildling permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit
Number:
Building Permit Application
Planning and Development Services
/
Building and Code Regulation Division Commercial
Residential v/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Owl GOYd
P tC?P`OS:ED IIlPRQVWENT LDC.�4Tld"N
a
Address: O
4 1p�e_yC V:::�•
Property Tax ID #:
Lot No.
Site Plan Name:
Block No.2
Project Name:
TAILED DESCRIPTION OF WOR I
It
New Electrical Meter Second Electrical Meter
(Affidavit required)
CO`NSTRUCTI N. INFORM, T10N:
Additional work to be performed under this permit —check all that a
_Mechanical _ Gas Tank _ Gas Piping _ Shu
_ Electric _ Plumbing _ Sprinklers _ G
Total Sq. Ft of Construction: Sq. Ft. o
Cost of Construction: $ '�)Utilities: _ Se
OWNERAESSEE: CONTR
R R
Name r n I Name:
(f M CL it
Address: 1GOL1 ) C1 V11 SVtCompany:
�C� ce
City: State: VZ4- Address:
i
Zip Code: Fax: _ City:m
a ado State:
Phone No. — E- Zip Code:
U _ Fax:
Mail: Phone No
- `,Q)Gj • 140o
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County
License i C�U ts 14��
If value of construction is 2500 or more, a RECORDED Notice of Commence
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencemen
f SUPPLEMENTAL CONSTRgI',ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State,
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
_ Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commenciniz work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLO A
COUNTY OF��LtI(�'4�,
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this AJ& day of V 1-b 2022by
kA1(,h(,a1 TilIU60
Name of person making atement.
Personal) Known OR Produced Identification
Y
Type of Identification Produced
(Signs ure of Notary lic- State of Florida)
Apt'w,q . ASHLEY ELLENORA DAMS
Commission No. eal) ' Coinmission # HH 226':K6
�, F Expires February 9, 2026
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