HomeMy WebLinkAboutBuilding Permit Application F
APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED
r / IatePermitNurnber. d�- D 1 `� `1
Building Permit Applic; on
Planning and Development Services
Suild/ngand Code Regulation Division COrninercial Residential (/
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(712)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address: 77 �. • 4YOyl cf� y� 4 i ecce _ -L - 3 `� 2 -
Property"fax I D#: `f' oc, �— - -- boo - Lot No.
Site Pian Name: Block No.
Project Name:
CAL
New ele cal Meter Second Electrical Meter
Additional work to be performed under this permit-check all that apply:
—Mechanical i 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:$ Utilities: —Sewer _Septic Building Height:
1131,11111: 111
A.
Name `/l e-7, Name:
Address: i-n o '( Ce)ro ice 17) ay, Company:
City: F tly,;- p j elcc - State:FL Address:
Zip Code C 'Fax: O Q2 t 2-q 309 City State:
Phone No. I rl_�., q0g-c S6 r0- Zip Code: Fax:
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 isrequired.
If value of-HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESI ENGINEER: r_Not Applicable . MORTGAGE COMPANY: :,;_ Not Appticab[e
Name; Name: -
Address. Address:
CRT State: Uy State:
Zip: 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 madeto obtain a permit to,do the workand installation as indicated
A ceMfy that no work:or instailation-has commenced prior to the issuance of a peirmit "
St.Luce County makes no representation that is granting a permit will authorize the it holdefto build the subject structure —
which is in conflict with any applicable Nome Owners Association rules,bylaws or covenants that may restrict or prohibit such
structure.Please consultwtch your Home Owners Association and review,your de [or any restrictions"Which may apply.
In consideration of the ranting oFtfiils requested'permit,I do hereby agree that I wild In all respec%perform the work
fn a=rdance with the approved plans,the Rorlda Buildingrodes and St Lucie County Amendments.
The following building permit applications are_exempt from undergoing a full concurrency review:room additions,
afire ary'structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TQ O?IIENElt:Your failure to Record a likitiae of Commencemattt onlay result in haying twice for
irriprovemertf-td j/ou1'property.A Notice of Commencement must- retoftle t le the-public records':of St-
i.ucle County,and pasted on the 3obsiTe before the first inspection.If you intend tct obtain financing, consult
with lender-or-a-kattomey befaEe commencing.work or recordifig your Notice of Commencement
Signature er/Lesseii/cOffractor as Agent for Owner Slgnature of Convacxor/Utense Holder-
STATE OF FLORID¢.& STATE OF FUMDA
COUNN OE COUNTY OF
Swum to(or affirmed]and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Price or Online Notarization Physical Prmnce or Online Notarization
this L day of 24.'V by this day of .2C by
Name of person rhaking statement Name of person making statement
Personally Known. OR Produced Identification Personally known OR Produced identification
.Type of identification Type of Iderttiiication
Produced __( ' Producect
k"I &L J*A.&%
(Signature of No Public State of Flori }. (Signature of Notary Public-State of Florida j
HREY
Cothrriission No. :�' ��; AUDREY Comrniss'ion Nix _(Seal}
AMMiSS��G 300817
EXPIRES:March 8,2023
n envr�ers
REVIEWS FRONT, ZONING, SUP OR PLANS VEGETATION SFATURTI_E MANGROVE
COUNTER RE1fiEW
REVIEW-.- - '- REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
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