HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
° 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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �100 � by-c-e.lo r, ,c t
Property Tax ID #: jul 0 C Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
l,'Z ov-rJoy �' a pt la c. ILoaJr
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
L -
Block N .
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: of 0 Sq. Ft. of First Floor:
Cost of Construction: $ I!d , 500 Utilities: —Sewer —Septic Building Height:_-. _
' OWNERAESSEE: .CONTRACTOR; ... -- .
Name _ i nV e_ i. UU C Name: zFOS Ci) r-1Arh111-1,
Address: w to i= La< , ity _S Company: _FN%t _ v-} f r i Cart 1(L or, r, ,
_ I TT
City: �"� CA v'V , � y —State: FL �`(`� � Qro,�r.c-F _ if�r�
Zip Code: &SI30 Fax: City: fi oy k L a uJ a rclg dt_ State: F L
Phone No. 3DS — 7 5 l ij 6 E- Zip Code: ?� 0111 Fax:
Mail: ,` iFi"k e l � L e n4-t Y - }c f-io4,at I. Phone No
Fill in fee simple Tltle Holder on next page (if different ° ' E-Mail &I a. r c P v, I i a e- c ti " r
from the Owner listed above) State or County Licensee C C 0 55 5%6
If 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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
improvement to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Counn nd posted o the jobsite before the first inspection. If you intend to obtain financing, consult
with lend or an attorn before commencin work or recording your Notice of Commencement.
7ATE
a o filrlot aor-OwVuilder as applicable
O F FFLORIA
COUNTY OF 2 [ o%-J ON r _
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of t1a v __, 2pj: by
DO 5 V' �"l p►r. ►1 .
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING ++
COUNTER I REVIEW I
RECEIVED
[,'01rP('
Notary Public State of Flonda
Marco A Monroy
r My Commission GG 297622
Expsres02103-2023
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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