HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BF ACCEPTED
Date: Permit Number:
a
Building,PermitApplication
Planning and'DevelopmentServices
Building and Code Regulation Division Commercial ,Y Residential
2300 Virginia avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: 17or%,rux - o�a�
PROPOSED IMPROVEMENT LOCATION: 6LC^_ 05
Address: (i C t-a-/1 [�r( ✓,e- 91 J 0 ,
Property Tax ID#: qJD;),- coo( - bG 3^GAO - 3 Lot No.
Site Plan Name: Block No.
Project Name: i(' Igo a
FDETAILED DESCRIPTION OF WORK:
Coen-r.A a�- �-t)Ct LA a -e_S %,ht-s c art k , O aart t
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank ^Gas Piping _Shutters _Windows/Doors _Pond
_NCElectric Plumbing Sprinklers Generator Roof Pitch
Total.Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ !�fs} Ca(D . °= Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: _ CONTRACTOR:
Name 1 rICL or-0-0 _ Name:-J-S�&n t;jns. tti- ' (a!- {
Address:!a S�-b S ac-e a-r\ 0r l�..Q. a c�1 Company: — I
City: d;2As-u\ hl'o� State Address:_[ 0-915 5 Diu
Zip Code: 34aS�-7 Fax: City: ��'-AS.QA State:-P.(—
Phone No. 914- i3-3'75.1 Zip Code: (3ggZ, 1 Fax:
E-Mail: i iA ekutaOS Phone No "? )a--D` '-7 --�-3
Fill in fee simple Ti#a Holder on next page(if different E-Mail 4--2
from the Owner listed above) State or County License �-C7
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: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER, _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 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 lender or an attorney before commencing work or recAlrip,vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Sig:PEOF
of for/License Holder
STATE OF FLORIDA ST FLORIDA
COUNTY OF ;!>"f', COUNTY OF ->r.- (.u_c—i.
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
W Physical Presence or Online Notarization WPhysical Presence or Online Notarization
this idayof f'tw. L: � 20�by this day of .u.i� 20 Dby
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification X _ Personally Known OR Produced Identification V
Type of I ntl I Type of Identification
Produ d ts L Produced DL.
T_�� ///'� )//'- 1��
{ ignature oQu� Publir/MIi#;' E ida} (Sigiliature o IY?� ic-S da)
' Commisslon#GG 318620 Commission#GG 318Qu
Commission n e iy28 202 eat) Commission N64 Expires July 28,20��„a1)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.