HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO -MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
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Permit Number. �, , 0
RECEIVPD
Building. Permit Application
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commerdial Residential
NOV 1.7 1010
Permitting Department
St. Lucre County
I PROPOSED IMPROVEMENT LOCATION: I
Address:
y
Property Tax 1D #: U- SO - 06,e g - 000 Lot No.40
Site Plan Name: _ f Block No.
Project Name:
DETAI LED..DESCRIPTION bF WORK:
New Electrical Meter Second Electrical Meter
CONSTRICTION INFORMATION:
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: 1A 0 Sq_ Ft. of FirstTloor:
Cost of Construction: $ //, 000• Utilities: _Sewer. Septic Building Height:
OW�lERjLESSEE:
CONTRACTOR:_
Name
Name: r
Address: 0000
�Company-2�
City: fizzz at -State,
Address: 0268 - id Yf !� �l�.iArx,iG� ee
zip code: g5 9� / Fax:
City. ��h .� Stater
Phone No. &)cQ 1b70 - y$.?D
Zip Code: J$ }A� Fax:
E-Mail: ATSdDT e YQgee, C ONi
Phone No 77A 442 " 4"7
Fill in fee simple Tate Holder on next page t if differeltt
E-Mail f f 6 C ONES GM IL
from the Owner listed above)
State or County License eke Jd.,f ��.�yV
if value of construction is 2500 or more, a.RECORDED Notice of Commencement is required.
If value of HAW is $7,500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
"""'�+•�n/ c�YV111)CCK: Not Applicable
Name:,
Addres
City: ot.J State: �
Zip: 6 Phone S/3 37y03
FEE SIMPLE TITLE HOLDER: X-Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
ROMING COMPANY: ,,k Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIOVIT: 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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cofil ict with any applicable Horne Owners Association rules, bylaws or and covenants that may re trict 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 1 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, wails, 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 gran attornpv hafnrc
Signature
as A e for Owner
STATE OF FLORID11 l..l�(�,'�
COUNTYOF
STATE OF FLORiiDA 1 u �,
COUNTY OF 771— L
.S to (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization to (or affirmed) and subscribed before me of
this _day of ��---__ 20 Physical Pres ce or Online Notarization
by this day of 2a by
ftn
ent. IliName ma i tatemName of persoA miVingWtement.
Personalty Known2!�2_OR Produced Identification
Type of Identification
Produced
Of Notary
Commission
Notary Public State of Flonda
Bunnie Merritt Woodard
Myijssion HH 039826
Expires 0 /07/2024
Personally Knowne(40 ,OR Produced Identification
Type of Identification
Produced
Of
Commission No.
11401104 Notary Public State of Florida
�F B(Sn*rntt Woodard
My'Com assion HH 039b26
•y ,; , d Expires 09/07/2024
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VIEWS�F�RONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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