HomeMy WebLinkAboutBuilding Permit Applicationf
All APPLICABLE INFO MUST BE CGivir- LETED FOR APPLICATION TO BE ACCEPTGu
Date: �� Permit Number: QQ 0 5 QL94! '
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVE_MENTLOCATI;QN:
Residential ✓
Address: ?.tYI S�[, g'f�yO�V e� A-\u,Y it .'Pbyi(1VMi-U0i°'EL_ 'S\40I1-52
Property Tax ID #: N 1 ?s 5 O — 2 Lot No.
Site Plan Name: Block No.
Project Name:
D`ETAILED'DES;CRI-PTION 01= WORK
R\v vYnihv M f) 0 M f a n -e f o-,c, c r"I (.t-i"'iwn 4's ° 1 0x-::s U l
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTUCTIQN NINFORMATIQN
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 Constructi n M l , o� Utilities: _ Sewer _ Septic
Building Height:
OWNERjLESSE,E
CONTRACTOR;
Name. 1 A.D C M 19 (.0 8 t-b
Name: j
Company: [1
Address: 71 &4 Q, U S � v 2 3 �—
Address: TU I :3 S �- !Zy p[ VA 8N mv s,
City: V) by 1i S(�,1 V \_\J Li � State: V
Zip Code: '�4 q rj2 Fax:
Phone No. 0 J J o E-
City: 4?_ State: �—
Zip Code: Fax:
Phone No
E-Mail nk, CuIVY&Cfi 1 .
State or County License
MailIbAR LCMtYn(,+%a C,OY�� Qom•(,O
Fill in fee simple Title Holder on next page (if different
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.
f
DESIGNER/ENGINEER: ✓ Not Applicable
Name: _
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
✓ Not Applicable
State:
of Applicable
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 your Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF SST U C e
Swo(n to (or affirmed) and subscribed before me of
"Physical Presence or Online Notarization
thisIy dayof Peer 202 by
II
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6
�/Y�( a� J� r�
Name of person making statement.
Personally Known "_' OR Produced Identification
Type of Identification Produced 11.
(Signature of Notary Public- State of Florida)
��r: LINDA HALL
Notary Public - State of lFloridaCOmmISSIOn
:?� Commission # GG 309GW"
NO.j
t �Y (Seal)
OF "'
My Comm. Expires Mar 7
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DATE
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DATE
COMPLETED
Rev 10/12/21