HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number:
�=---Building Permit Application AIgR
Planning and Development Services 15 �022
3t. Lu !a
Building and Code Regulation Division Commercial Residentr��`yn
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
//
P%Uul GJJ: / r _/ I I ' ^ -
Property Tax ID #: 113 `OV 0 2 D 60 - 17 Lot No.
Site Plan Name: Block No.
Project Name: Ped, ➢ �'� L�
DETAILED DESCRIPTION OFWORK: °
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 _ z
ows/Doors PondElectric Plumbing Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �%, 20 �.� Utilities: —Sewer —Septic
Building Height: 0
OWNER/LESSEE:.
CONTRACTOR:
Name k, 4 ۥ 4ti-r'
Address: S%/Z�"" J"` _��r��
:.c f:k f
r /lo t �-rr c�2
Name:Z-
Company: 4 e-Z- C& -14N25,
City: &I I, "�L' cam.
Zip Code: JYF/ (:P Z-
State:
Fax:
Address: 1511 dC 6" 14-( 4v--
City: Stater
Phone No.
[02 E-
Zip Code: _? Y�& Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
Phone No 772 z3 Z V'hz
E-Mail ,r'o� - vt_
State or County License L' CC, p- 7z-s- '
from the Owner listed above)
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 -
DESIGN ER/ENGI NEER: _ Not Applicable
MOMM_ M� A T1ifN _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
HEEEM-19R-LERM � -NOME", _ 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
improvements to your prope y. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted o e jobsite before the first inspection. If you intend to obtain financing, consult
with r a ttorn efore q=mencing work or recording our Notice of Commencement.
Signature Contract - or - Owner Builder as applicable
STATE OF FLO DA
COUNTY OF MARTA
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this It day of AAARGu 20 2Z by
Ray vkef. ksaEZ
Name of person making statement.
X
Personally Known OR Produced Identification
Type of Identification Prod ed
(Signature of Notary Public- State o lori
Commission No. (Seal) �40►.� Notary Public State of Florida
Richard P Brockweiy
My Commission CMG 221519
�joi1►
Expires 05/23120/2
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COMPLETED
Rev 10/12/21