HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�-I I- -? Permit Number: 0 AL3
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91r.WME-1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-I553 Fax: (772) 462-1578 C13DG Funding
PERMIT APPLICATION FOR: AOK 000 'ST9uC-71,,'XAi—
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N '0:t P A 0 S� IMPROVEMENT
Address: <3600 S. 0CF-AA) bK, Afr 1101 3640 -Ra4CH1 FL 3(.cI.T7
Property Tax ID #: 15739-502-0052'-Oco-0 Lot No.
Site Plan Name: Block No.
Project Name:
DETA
ILED .DESCRIPTION -OF- 0
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F-AIS-11A)C, MrStl\i6i 2
New Electrical Meter Second Electrical Meter (Affidavit required)
,CONSTRUCTION INFORMATION
Additional work to be performed under this permit- check all that apply:
—Mechanical — Gas Tank — Gas Piping Shutters Windows/Doors Pond
J�-Electric ,Plumbing — Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: �00 Sq. Ft. of First Floor: 233(70
Cost of Construction. $ Utilities: )( Sewer _Septic Building Height:
CONTRACTOR" AU,00'
Name r)ll & Yl�MI40bE
Name: 1>&JA Sy'v) 714
Address:1?GQ0 'S. CO-',40 bK 6+'1 )101
Company:'D" sy" 4- `x3A)S OA
City:ZS590 ?)PAL h State: FL
Address: IL2 5LJ 13000kit) 7lt,10 C.-
Zip Code: 3q 95-'} Fax:
city: -5-ti6KT' State: f--L-
Phone No.5'1 2-- 2,9 S - &33 z E-
Zip Code: 3J91 � Fax:
Mail: I rn on ftl & 140L. Co ryl
Phone No !�7>gl- 146-102q
Fill In fee simple Title Holder on next page (if different
E-Mail -bAkA 5oAj9Q A^41L. (:om
from the Owner listed above)
State or County LicenseclwT 15 19 3 -S
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
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SOPPLE�MENTAL CONSTRUCTfON LIEN LAW INFiDW WON ~ g„
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:MIC14AEL AybF,KGanL.;'
Name:
Address: 1194 Hwy A 0
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Address:
City: :LAJWak) i-i dRzov 2
State: _[_-_
City: State:
Zip:'32613)t 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 attorney before commencing work or recording your Notice of Commencement.
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Signature of Con ctor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworncto (or affirmed) and subscribed before me of _,k Physical Presence or Online Notarization
this L day of 20Z�by
3? Q� � �, �' III 1 '�1�-
W.
•� ,�,P•........, �,
Name of person making statement.
TY
Personally Known OR Produced Identification x
My Comm, Expires
_ •November 17: 2022
Type of Identification Produce 0 fit) uYlil G►",4
No. GG 276275
(Signature of Notary Public- State of Florida)
Commission No.
I
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
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RECEIVED
DATE
COMPLETED
Rev 10/12/21