HomeMy WebLinkAboutBuilding permit app-initailedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: n nA �- Permit Number: A2 ti 3 'o�?w
J Uo Ll�,�llLS,\ RECEIVED
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Building Permit Application
Permitting Department
Planning and Development Services St. Luoi County
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:
Address: in 1
L-fpa
Property Tax ID #: 34Doi ` (o D3 - 0 1 LL, f1i Lot No. t
Site Plan Name: Block No.
Project Name:
x � � c� oue ►e
New Electrical Meter Second Electrical Meter
(Affidavit required) .
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:_$ Cpy-2� - tilities:..... Sewer Se tic: BUIldin 'Hei ht:
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Name-0-1 a-i �r►_��'Ce (Sep ► -1n(iZ %la u cr-
Name:. M A9,V_ !E>
Address: l -e-
Company: Ja
Address:
City: , State: r-f-
Zip Code: a44 q eoZ Fax:
City
State:�l _
Phone No. -/-73 _ Oqy 3 E-
Zip Code%'�L 6i $ol- Fax:
Mail:
Phone No -77�- `a 5-1-L42 0.7
Fill in fee simple Title Holder on next page (if different
E-Mail-CAQ A-G,,(
,Gory)
State or County License C9( 9
e
from the Owner listed above)
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.
DESIGNER/ENGINEER: ! Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
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,1 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 Couq)y arld posted on the jobsite before the first inspection: If you intend to obtain financing, consult
with lencw orAn attowev before commencine work or recording vour Notice of Commencement.
Sig t r �of Contractor - or -Owner Builder as applicable
STAT OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of L/
Physical Presence or Online Notarization
this k-_? day of tq f5r - , 20�by
Name of person making statement.
Personally Known OR Produced Identification
Type of Ident ' duced
_
(Signature of Notary Public- State of Florida)
Commission No. Hq _79'�)b_a (Seal)
GABRIELLE HICKS
_:° �'I�Notery Public -State of Florida
=• •= Commission M HH 79502
My Commission
Expires
February 02, 2025
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