HomeMy WebLinkAbout20220329_161801.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 1 a UI a;c
Permit Number:
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Q e C . L L, -° - Building Permit Application
Planning and Development Services
Commercial Residential
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: "CCA-ear Go ��oYl
PROPOSED IMPROVEMENT LOCATION:
Address: I o.wE'r
-sc-e_rr \\,tr\'l� \4� QJ'
Property Tax ID #: 3d1 - to - o2N - -OI Lot No. l�
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank
Electric _ P ul mbing
Total Sq. Ft of Construction:
r. of rnnctrurtion: 5 1.900
E:
Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
Address: O
City: 4Q- e -t r S tate: F
Zip Code: ' �CI5 \ Fax: 01
Phone No. rY)1 ) - I--1 0� \ 1142 (PZ E-
Mail: N IH
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 4
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City: State-A--L
Zip Code: -3HQH4 Fax: --
Phone No ,f ,o - MW 101,09
E-Mail �' r^oal n1lfhLl\tlrnPc�mDnrlil(o� �mnJ.c m
State or County License - log0
of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECURULU Nonce m „.... •-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip; Phone:
Not
Name:
Address:
City: State:
Zip; Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
Zip: —
Phone:
...I, .....I ;-to l l nrinn nc indirated
.
OWNER/ CONTRACTOR AFFILIVII: Applicatio
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 yo�li *teQndf o obtain financing,
consult
with lender or an attorney before comMerILIT19 wUl M1
of Contractor - or - Owner Builder as applicable
F
OF FLORIDA
Y OF A fit UQ
�hysical Online Notarization
Sworn tor affirmed) and subscribed before me of Presence or _
20_2 by
this 2'6 day of Mw-c k) ,
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Name of person making statement.
/OR Produced Identification
Personally Known
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Nt
tary Public Stets of Flotltle
ichelle Trottay
Commission HH tO100txpire,
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