HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q Q
Date: PermitNumber:p7216 L"0
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p - ` ` �w 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
PERMIT APPLICATION FOR:
I?`ROPOSED ;IMPR.OVEM-kNT`LOCATI'ON.
New Electrical Meter Second Electrical Meter [40,4 of-LjUfk, J7 -%(Au&0;' vuuS5
CONSTRUCTION, INFOR;IVIATION., ,.F
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� I (��� Utilities: _Sewer _Septic Building Height:
OWNE1R/LESSEE
NName
CONTRACTOR
y�-
Name:
Address: " 5� °s I)e .�_ lls•.
y � i
Company: '
p y: �C�[�!n Cd�>rrrx;4i'bti .—Ija.Z.
City: u. &e-&,>,
State:-C
Address: 101i IjE
Zip Code: 3q WSJ}- Fax:
City: State:
Phone No.i!n
Zip Code: 'S�t4Sa Fax: 47.2- 67f-6:4X
E-Mail: :]Jj j ".7.5 C,j^ ,(Q'5z" a i ./awti
Phone No
Fill in fee simple Title Holder on next page
(if different
E-Mails, Pu�s4rl4,e,.-14 4, r-
from the Owner listed above)
tat 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.
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1'
DESIGNER/ENGINEER.
Name _� �Cv-17 l�Aruth
— Not Applicable
rLrASiyL�C�1-.8
Address. !W
�y+:••
City:
Zip: tlbq Phone S
Stater_
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
Address:
City..
Zip: Phone•
O,RMATION.: -
MORTGAGE COMPANY: iNot Applicable
Name:
Address:
City: State:
Zip: Phone:
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 noworkor installation has commenced prior to the issuance of a permit.
which is in conflict with anrepresentation
applicable' Hothat
e Owners Associationrul Ies abylaws or andpcovenants that build
drestrictbor prohibit such
structure. Please 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 attorney before commencing work or recording your Notice of Commencement.
,
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF
S o n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this !% }K day of V k 202t by
IA 1.� ' tr(nntti
Name of person making statement.
Personally Known k OR Produced Identification
Type of Identification
Produced
( nature o otary Public- State of Florida )
NCO
Commission No. ��"��� (Setsson# 32fsng
20 , Com ri129.2023
�,� * 6XPtites APne� No1au�'9ervlcas',
REVIEWS I COUNTER NT �rR®VIEW I SUPERVISOR REVIEW
TE
MPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 511✓ day of _-Af'Vy,s4- 202Q by
I�l LA-1 r//A✓i x
Name of person making statement.
Personally Known )-- OR Produced identification
Type of Identification
Produced
(Sip ature of Notary Public- State of Florida )
Commission No. 3ZS, 7�
(SeaJ�NNA, FRANCO
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PLANS VEGETATION SE�q g d#�II gO
REVIEW REVIEW RE�tEW REVIEW