HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date:
FOR APPLICATION TO BE ACCEPTED
Permit Number: zoo Z
RECENED
Building Permit Application Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: Q!0'L -7 Kia woiVl -- -,ice I Poet S-F. L-ucit i F I 3ggrfo
Property Tax ID #: 3 3Z 1- -70 S- - D Dti 3" 000-0 Lot No. I-/ Z
Site Plan Name: Block No.
Project Name:
New electrical Meter Second Electrical Meter
Additional work to be performed undenthis permit;- check all that apply:
_Mechanical _Gas Tank - '_GasPiping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Winddoows/Dodrs
�/ Roof
Utilities: _Sewer _Septic Building Height:.
Pond
Pitch'
Address: Q!0'L -7 Kia woiVl -- -,ice I Poet S-F. L-ucit i F I 3ggrfo
Property Tax ID #: 3 3Z 1- -70 S- - D Dti 3" 000-0 Lot No. I-/ Z
Site Plan Name: Block No.
Project Name:
New electrical Meter Second Electrical Meter
Additional work to be performed undenthis permit;- check all that apply:
_Mechanical _Gas Tank - '_GasPiping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Winddoows/Dodrs
�/ Roof
Utilities: _Sewer _Septic Building Height:.
Pond
Pitch'
Name r?Alim! C-,J-1✓J ehol"J's k
Name:
Address: ko21 . ICil3.ulall }r0.0
Company:
Address:
Hl/ cT 11/8 -3"tllcj)e5
IDo 0 YU
d
City: P0✓1- Sl . Lucie 4 State: P/
Zip Code: 31-f9 pio Fax:
Phone No.
City: Pry^b✓0
Zip Code:
Phone No
p,nc S
3302.G Fax:
°IS-cl-82z-(4S-W
Stater
'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail M e' S k , ✓I � Its d9
�q fly- 600N
State or County License cr,c ;I I
3 3 Zy I L
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. / -7 I p�
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. 3 1 I I 0
L 01! fNOAlOE�7
lPP PIS71FN7�A � ° NSTRUCTI 3N
spa..-IN4 "be, a
=
MORTGAGE COMPANY:
Name:
x1 `;
4
'`` VI N
_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
_State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 lonrlor nr nn nttnrnav hpfnrp rnmmpnrinp wnrk nr recording vour Notice of Commencement.
Signature of 0� ssee/Contractor asAgent for Owner
Signa ut re of Contractor/License Holder .
STATE OF FLORID
STATE OF FLORIDAri 1 .. '
COUNTY OF ��
0
COUNTY OF c i- W ole
Sworn or affirmed) and subscribed before me of
hysical Presen a or Online Notarization
Sworn or affirmed) and subscribed before me of
Physical Pres nce or_Online Notarization
this dray of 2Q7-D by
thisjgday of 20 by
2 1
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ide cat oil
Type of Identifi n
L
Produ
Pro uc ...... Jason Hendry
���C a=
commissbn0Gom
-
(Sig ture of Notary Public -St � �Wida) . Jason Hendry
���r=
ign ture of Notary Public-Sta ��)iruT '
Bonded Thru Aaron III
CommfssbnffiGG
,GFWM�N`
C on No. `x. xe February 23, 2
- i
o ission No. (Seal)
pires:
'%oy'' o' Bonded Thor Aaron No111rY
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Rev. S/b/LU