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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE. COMPLETED FOR APPLICATION TO BE ACCEPTED j( v9 ,�j rD Date: — I� 26 Permit Number: ZOO— � T Building Permit Application Planning and Development Services A 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: /6 j Property Tax I D # Site Plan Name: Project Name: M haver ` Ku—ce 2.19�19r a 14(4- bb0b' � New electrical Meter Second Electrical Meter Additional work to be performed under this permit— check all that apply: _Mechanical _ Gas Tank _ Gas Piping —Shutters Electric _ Plumbinghh _Sprinklers _ Generator Total Sq. Ft of Construction: 3 ( V Cost of Construction: $ ,'; Dp© . oa Sq. Ft. of First Floor: Lot No. Block No. Windows/Doors, _ Pond Roof - ` Pitch Utilities: _Sewer _Septic Building Height: va 4 [ �� $z- } � 5 � .. w� -�i �` � 'L��"F`�"4i' .�"i*��g,�h 4 71 � o� ssf�s f�.y� �N-rcaR €� iv:... ,.�-=.��...&£ z",>Y, },Y"'k�.3 4,A A?. ..z ,�'..e .�.>.1, _3.. ..:,.. .. .,.P �s5. ?s 1 .,., a >:, m&*d. �i.._,...,4,6d."i., Name ectW M4 5000,; tovvt Name: Address: /to SS. CO Pe ,J i,,I� ear City: :E11- I91-e-.-c-P State: f ` Zip Code: 3y J y 5" Fax: Phone No. 'r� Z 5 5911'`6 to Company: Address. City: State: Zip Code: 'Fax: Phone No E-Mail: Fill in fee simple Title Holder on next page ( if different from -the Owner listed above) E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. �s...-;a .� 01117" ..'L"1 DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: _Name:. Address: City: Zip: Phone State: Address: City: Zip: Phone: State: 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 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 agreeihat 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 IAri#k lonrlor nr 7n nttnrnnv hafnra rnmmencing work or recordine vour Notice of Commencement. Sign .ure wner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder . STATE OF FLORIDA STATE OF FLORIDA COUNTY OF GC j COUNTY OF S,worn 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� b this day of 20_ by A • i� 5 Name of person makinA statement. Name' of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification 7 Type of Identification Produced nt/ ?A Aw Produced — (Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida ) Commission No. 11111 ELL AUGHN ue�=state Commission No. (Seal) _°` of.Florida-Notary Public -+ r_ REVIEWS OF ��o�° F My Commis bar idn Expires - ERVISOI PLANS' VEGETATION SEA TURTLE MANGROVE COUNTER PTE7 ' REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 5/ b/ LU