HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� �`
Date: Permit Number: SLC 1 02 - 0Z IS
91 r. ILUC HLe — ® _
Building Permit Applicationl-
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: 4 H
Property Tax ID.#:
Site Plan Name:
Project Name:
- 2_3O -OWq-D
DETAILED DESCRIPTION OF WORK:
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
Electric _ Plumbing 4sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name a OUCLn
Name: GaN AnderSOY)
Address: PO P)OX U,� 00-7
Company: Ab C.ON1' me' YrJ►(J'1.
City: 1=1— LQ+U �1'(.1 L State: fJ,
Address: 315 d SW L f .)- AV f -
Zip Code: Fax:
City: Nlli I G(r State: �L
Phone No. TOOL 03,D- -2-00 1 E-
Zip Code:�J GI� U Fax:
Mail:P611 WC-1- PtYrY)[+-.s_ •COVII
Phone No
Fill in fee simple Title Holder on next page (if different
��f
E-Mail T>� M G 1 7 e-F M J fiS
from the Owner listed above)
State or County Licensee 1400 0 VL
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required. II
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
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 attornev before commencing work or recording vour.Notice of Commencement.
Signature of Cont ctor - or -Owner Builder as applicable
STATE OF FLORIDA
Q�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this2Z day of XC, 2024 by
Con Wt ry r)
Name of person making statement.
V
Personally Known OR Produced Identification
Type of Ide d
(Sigh e o otary Public- State of Florida)
EMILY TAV_RAS
Commission No. (Seal) Notary Dublic - State'of Florida
Commission = HH 096709
P.t.P5 MY Comm. Expires Fen 23, 2025
Borded through National Notary Assn.
aw-M
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DATE
COMPLETED
Kev 15/12/21