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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ow Permit Number- 002y .
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Building Permit Applicati n
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Planning and Development Services
Building.and Code Regulation Division Commercial ResiderItial.__ — --
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (77 2)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: yge S ir / PAP,n�SA Vb- �5L , 3 YR83
PropertyTax ID#: " S,,3D ©O/g , 000- a Lot No. _
Site Plan Name: 4qi✓E Ile PARK — om 1 T Block No._�
Project Name:
IJETA LEQ DES�R! eT Ql a(7�F1/DR F'Y
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4f11-D4AJ1N(10 I>AlVe, 10p\1 S&e- II'AAKAM
010-K 0-aNc*9,1� w ITS- F Br-,
New electrical Meter Second Electrical Mete -oA)&
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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:$ ©�.DQ Utilities: —Sewer _Septic Building Height:
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Name �VSw Name: A)
Address: y/(o AIJ4A-Af-) sI4 Company:
City: fifer 15AIAI,'r I VCI*, State:VL Address:
Zip Code:?,41Q? Fax: City: State:
Phone No. S� o�5y 5007 Zip Code: Fax:
E-Mail: r f7a SMrn \^^p A'fiT%NfI", 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.
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DESIGNER/ENGINEER: . Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: XNot 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 witK any applicable Horne Owners Assodation.rules,bylaws or and covenant�Ahat 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-r.'espeets,'-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 attorne'"before°commen cin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA4, - STATE OF FLORIDA
COUNTY OF COUNTY OF
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Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 20_—!>Vby this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known' OR Produced Identification r Personally Known OR Produced Identification
Type of Identification Type of Identification .
Produced Produced
(Signature of Nota r ublic-State of orida ) . (Signature of Notary Public-State of Florida)
.•k�:Ye�-'' AUDREY PHREY `
�o• G� �
Commission No. COMMIS ONJGFIREY 7 Commission No. (Seal)
EXPIRES:March 6,2023
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REVIEWS FRONTy~ ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW . REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.