HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTECW
Date: 3. �. Permit Number: 55 a 1.
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Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Z),eAIMof- /Z-l�-
PROPOSED IMPROVEMENT LOCATION:
►,aara — 3 / D y ia- vifej" if I,
Property Tax ID #:
Site Plan Name:
0
Project Name:
DETAILED DESCRIPTION OF WORK:
RECENED
Building Permit Application
St. Lucie County
PermittinS
Residential
MAR 17 2022
)"2-' 2 7'
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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:
Cost of Construction: Z O 0 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -72 tLO-;
Name:
0 /k✓ I��i� ;1Q+;:
Address: I �JLL/
.Company:
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City: r o 2 T I`y /Z-�E'State:
Address:
Zip Code: 3 V 9 r '7 Fax:
City: State:
Phone No. 9 "5 y — 39 3 8 9 E-
Zip Code: Fax:
Mail: fogy -4-/&rZ 0 /!5 A4 I M✓>i-f, C0,41
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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:'
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State: A
City:
State:
Zip: Phone
:1 j J <':
aZi{p .. ,, .L. Phone:
FEE SIMPLE TITLE HOLDER:.,;._
Not Applicable
BONDING COMPANY:
v
=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 -an 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 accordance4ith'th`e 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 usesto another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result ih,paying'twice for , f
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 lintend to obtain, financing,,consuit
xnnth Icnrlcr nr an aftnrnav hafnra cnmmpnrtina wnrk nr rPrnrdingyour Notice of Commencement.
Signature.of Contract - or. -.Owner Builder applicable
r as
STATE OF' FLORIDA
COUNTY OF -�-� ) U,r
Sworn (or affir and subscribed before me of
ed)
Physical Presence or Online Notarization
this day of i3 20y
Name of persofi making statement.
Personally Known O Pro ced Identi ication •,. ;
Type of Identification Produced
(Signature of Notary PubIV State of Florida)'1-3 ::`';, . i
Commission -No. (Seal)
COMMISSION # GG-300817
Z�AUDREYBMUMPHREY
EXPIRES: March 6,2023d Thni Notary Public Underwriters
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