HomeMy WebLinkAboutBuilding Permit ApplicationAll, APPLICA LE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (Q�� • �(p(p
RECEIVED
Building Permit Application_ AUG 241010
Planning and Development Services itting Depa nt ent
Perm
Building and Code Regulation Division Commercial ReSidentialst.
2300 Virginia Avenue,, Fort Pierce FL 34982
Phone:.(772) 462-1553 Fax: (772f 462-1578
PERMIT APPLICATION FOR:
Address: o100-7 (/) ..
Lj_ +- %r,rce, ,-�_
Property Tax ID #: �4ou - J�OI • Q3(o •Q�t7
Lot No.
Site Plan Name:
Project Name:
New electrical Meter . Second Electrical Meter
Block No.
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters — Windows/Doors y _Pond
_ Electric _ Plumbing —Sprinklers _ Generator Roof y "Pitch
Total Sq. Ft of Construction: - Sq. Ft. of First Floor:
Cost of Construction: $ -) 14 o - (j l`� Utilities: _ Sewer Septic. Building Height:
Name
Address:
City: 9�Ll"� State:
Zip Code: Fax:
Phone No. 7 7a II -
E-Mail: l �1I)V OIAG1.-t i V1(`1 1 U) C0 IAA C 11S , 0
Fill in fee simple Title Holder on next page ( if different
from -the Owner listed above)
Name:
Company: -
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereoy mane zo UUW.14 a N=1 M4.-
ceitify that:no work or'.installation:has commenced prior.to the issuance of a permitp'
ttyy representation
le Nome Owners Association rules, bylaws or and 'covenants that may,
restrict r roY ibit sre
St. Lucie n conflicmtakes an r appsenttation that is granting'a ermtt w>II authorize ed for
it holden ooreuild aemab�a pstructu uch
which
rtuctture. Please consult with.your Home Owners Association and review your de Y
In of the granting of this requested -permit, .1 do'hereby agree that l will;'in-aU respects,$erforrn`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,usesto another non-residential' use.
rope . A`Notice of Commencement must be y result m paymg.twice for-
WARNINP TO.0WNE Y Youpr failure to Record a hatice:of Commee onnlf orecorded rn'the<public records of St..
improvements.to; oun p Y, u Intend'to obtain financing, consult
Lucie County and posted on, the jobsite before the first rasp Y
mvith lender -or an attorne efore commencingwork or recording our Notice of Commencement.
re of w!EP?
nr�/ss a/Contractor as Agent -for Owner Signature of Contractor/License Holder .
STATE.OF-FLORIDA STATE OF.FLORIDA
COUNTY OF COUNTY OI"r'
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thiso�L day of 20e2rj by
Name.of person m�ngatem
Personally Known OR Produced Identification
Type of identification
Produced
(Signature of Notary. Public- date of Florida )
Commission No.gbgHNAIN6P46'ftP•FIM►N`3
i' MY COMMISSION # GO 275060
Sworn to (or affirmed) and subscribed before me o
Physical. Presence or Online Notarization
this day of 20_ by
Name of person making statement/
Personally Known OR Produced.ldentification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal).
Q` Bon edThruNota Public 'Ideffilrr I;
I FOF F�4.•
REVIEWS SOR PLANS' VEGETATION SEATU.RTLE MANGROVE
COUNTER REVIEW REVIEW 'REVIEW REVIEW REVIEW REVIEW
)ATE r .
;ECEIVED ...
)ATE
;OMPLETED
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