HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Lucm
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pier e FL 34982
Phone: (772) 462-1553 Fax: 772) 462-1578 CBDG Funding
PERMIT APPLICATIONOR:
PROPOSPED IMPROVEMENT ENT LOCATION:ssddre: `
A�
",Q- i-Crc �. �1
Property Tax ID #: DI ^- 60 I D ' _. CDC—)0
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
rr,
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 _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing — Sprinklers _Generator Roof -��� Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 3 S C-0
Cost of Construction: $ cp c-)p Utilities: —Sewer —Septic Building HeiEhtt -a D
OWNER/LESSEE:
CONTRACTOR:
Name (°inc4-, c7 j2)r
Address: �®-5 hve—
City: f'4- Pf C r G e.
2Dim e
Name: �-Vis uir)oocs
Company: 0;,- 0 X-00 /aS
State: 1-
Address:
r
Zip Code: Fax:
Phone No.
Mail: (=0 Oaf S
City: r7,L State:
Zip Code: _3 Fax:
Phone No-772- - rp 7
E-
i C,:�):n
next page (if different
..ro o RCrnonrn n•:__ _� �_.__
Fill in fee simple Title Holder on
from the Owner listed above)
If value of construction is ?snn �r
E-Mail!/,®
State or County License C (-I-C-
� � cyuuea.
If value of HAVC is $7,500 or more a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW I RMATION:
— Not ApplicabJa MORTGAGE COMPANY: Not icable
DESIGNER/ENGINEER:
Name:
Name:
Address:
Address:
City:
Zip: Phone
State: City: State:
Zip: Phone -
FEE SIMPLE TITLE HOLD�E�
• _ Not Applicable BONDING COMP Y: Not Applicable
Name: �'
Name:
Address:
Address:
City: ,�
City:
Zip: Phone:
Zip: Phone:
OWNEIR/ CONTRACTOR AF
IDVIT: Application is hereb�issuan�ceof �pe�,rmit to do the work and installation as indicated.
I certify that no work or installation
has commenced prior to th
St. Lucie County makes no representation
which conflicts with any applicabl
that is granting a permit will authorize the permit holder to build the subject structure
Homeowners Association rules, bylaws or and covenants that may restrict
structure. Please consult with YOL
or prohibit such
r Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting or
in accordance with the approved
this requested permit, I do hereby agree that I will, in all respects, perform the work
olans, 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 our Notice of Commencement.
ner Builder as applicable
Signature of Co Kactor _ awPO"
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed
this � day of
before me of Physical Presence or Online Notarization
20 '-:��y
Name of person making statement.
Personally Known, %'_ OR P
oduced Identification
Type of Identification Produced
.
(Snatu
Notary PutWfc
Commisy Carmen M Qt
Sfate of Florida
ir)
FYCOMM4310rHH
Na,npl'v Expires 02/15/2
09327-7
25
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COMPLETED
Rev 10/12/21