HomeMy WebLinkAboutBuilding Permit Application All APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. 9O I l ' 030
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Building Permit Application
tanning and Development Services
Building and code Regulation Division Commercial Residential G
2300 Virginia Avenue,-Fort Pierce FL 34982
Phone:(772)462 1SS3 Fax:(772)462-1578
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PERMIT APPLICATION FOR
I IN
Address: 'Zo y Z G V 4;✓v'A-tom Tom ! 6�� %cam :3, Ltg5
Property Tax ID#: ZtA-z- �of 6 OV90- ( Lot No. !z.3.'t
Site Plan Name: VAA-e,&-vtu.-A- Block No. `11
P inject Name:
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70�* illkas s �oc�%c fC s�pP i�4' r/l-p Sc�
New electrical Meter Second Electrical Meter
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 X Roof FLAT-- Pitch
Total Sq.Ft of Construction. 00 Sq. Ft.of First Floor
Cost of Construction:$ 3:5W- Utilities: _Sewer _Septic Building Height: ;i
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Name an* Name: ewcacv4e�.
Address: ZoG2_ dArl,.1-75 -E� Company: L S [�-LI
City: J�c State:� Address: = Z?L 6,i j .� e, *S,c
Zip Code: ,�K.i�7s Fax: City: Stater
Phone No.- -z. !!U ZU Zip Code:3Lf,1gZ Fax: `77?i LL(a L=&L
E-Mail: Phone No `7 7 7� Z[,& `9&cV.?
Fill-in fee simple Title Holder on next page(if different E-Mail f'F65�n�;C�c�e`eo P aOcti,ca� r��c�
from-the Owner listed above) State or County LicenseeS'7-?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of W4VC 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:_ 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.
1 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 yo roperty:A-Notice of Commencement must be recorded in the public records of St._
Lucie County a post on the Jobsiite before the first inspection. If you ' obtain financing,consult
with lerWp&an a!Wney before commencing work or recording otce of Commencement
Signa re o wner/Lessee/Contractor as Agent for owner Signat re of Contractor/License Holder .
STATE OF FLORIDA STATE OF FLORIDA i
COUNTY OF �..r�,o COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presen o Online Notarization "Physical Presence or Online Notarization
this day of 20�by this C b day of IW Y ,2d by
Name of person making statement. 0 Name.of person making statement. QA
Personally Known OR Produced Identification Personally Know -OR Produced Identification
Type Identification Type of Identification
Pro MLW Pr&Wced
{Si a e of Notary Public-Sbwee of Florida). nature of Notary Publi Nate of Flori )
Commission No. (Seal) Commission No. eal)
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DATE
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DATE
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