HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I,1NFO7 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: -- _a l O�IU�J
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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 Cl3DG Funding
PERMIT APPLICATION FOR:
PROPOSEU.IMPROVEM ENT LOCATION-."',
Address: 3520 OV6 9/1 r
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Property Tax ID #: �0q12Y qlvoz —69o0—
6 Lot No.
Site Plan Name- Block No.
Project Name.
K
BL41'& 4.6rT--PJi ty?).Okm d>,-1
1'^1 1 "k-A Wved,.r
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCT[ON.IXFORMATION:
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
— P F'n 470.*-
Total Sq. Ft of Construction: 7015- -,(::�7 Sq. Ft. of First Floor:
Cost of Construction: $ Y'77—j 0aCX Utilities: Sewer Septic Building Height:
, OWNER/LESSEE-
CONTRACTOR.'
Name =v� ii Xc?j'A -e
Name:,a&/7t)/,3 vcfa/r
-&
Address: *9* '35YO Cycle -we .0^,ve
Company: 594P
Address: I �31 7 5# Moa
City: Fn-,81-P,^cr-' State:
Zip Code: 3 q Fax:
City: A �J I-,
State: FL/
Phone N . 7 E-
Zip Code: Fax:
5%I — j�joq
Phone No '772. ;t1-el
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail dil Q/ 4-7nQ 4Fi41,qJiC0.z-,A-t
State or County License_
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.
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DESIGNER/ENGINEER: _Not
Applicable
MORTGAGE COMPANY:
Applicable
_Not
Address: �lt�l 'h • l�r ���r: �
Address:
City:
State:
City: or elm d1l State: �L/
Zip: ' Phone q07 —
7 `3 y —1 t/7,0
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 commencins work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
f L.Ua�t
COUNTY OF ,
Sworn to (or affirmed) and subscribed before me of '-**Physical Presence br Online
Notarization
this.) day of20 111 by
Name of person making statement. �;_UTAIS ,` '4bx
Personally Known OR Produced Ide tification
Type of Identification Produced Ft -
(Signature of Notary Public- State of Florida)
DARBARAMILILLO
Commission No. �sl�aJ �fi (Seal) g� :=.�;"YPp4=. Notary Public
f _� : - State of Florida
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¢t� '17 of ` Commission # GG 237991
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°f•'' My Comm. Expires Jul 12, 2022
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Rev 5/20/21