HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:;),
9`llo E ulzulg" RECEIVED;
FEE 17 �022
Building Permit Application
,tuale
Planning and Development Services Pe G�OUn
ld g
Buildingand 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:• .1 .
PROPOSED IMPROVEMENT LOCATION:: '
Address:
Property Tax ID M. 3 647 . 0 Lot No.
Site Plan Name: Block No.
Project Name: Atv0&1-�
('DETAILED DESCRI PTION -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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers —Generator . _ Roof Pitch
Total Sq. Ft of Construction: 'Sq. Ft. of First Floor: .
Cost of Construction: $ f (7 r y) _ Utilities: _ Sewer _Septic Building Height:
.OWNER/LESSEE:.
CONTRACTOR:
Name
Name: 1
�qfJ l 1
Address: 6 ,.}
Company:, `
City: l aa5. -eJ 5t/ i State:
Address: us
J i
Zip Code: I Fax:
City: �LL1 G eM
State:
Phone No.
E-
Zip Code', Fax:
Mail:
Phone-No)�Z.-
Fill in fee simple Title Holder on next page (if different
E-Mai 1,1 V11A% t c� ✓� siw) L1��S
from the Owner listed above)
State or County License C. (,
IIIf value of construction is. Z500 or more, -a RECORDED Notice of Commencement is required. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
1.
utb1W[ tK/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone
State:
City:• State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
city:
City:'
Zip: Phone:
Zip: Phone:
v rr ni _%os• s nm�_ i vn mrrw vi 1 : Hppucation 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, byylaws 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 nr rpr•nrrlina Vnl Ir nir,+iro „f +
----------.--- ---••.
r
Signature of Contr ctor - or - Owner Builder as applicable
�• ���. �.... vw. .nv •.•.4.. VI VVII IIIIGII�.GIIIG111..
-
STATE OF FLORA
COUNTY OF 7 1 LyLGc.e
Sworn.t (or affirmed) and subscribed before me of
this day
Vhysilcal Presence or Online. Notarization
of 2022lby
Name of per n makinAstat nt.
Personally Known roduced Identific Ion
Type of Identification Produced
(Signature of Notary Public -State of Florida)
Commission No. (Seal)
�*P D4"� JAMES ROUAN
r:° • ��r„�� Notary Public - State of Florida
dFU ` . Commission k HH 55034
My Comm. Expires Nov 4, 2024
Bonded through National Notary Assn.
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ltev 1,0/12/11