HomeMy WebLinkAboutBuilding Permit App All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO ACCEPTED,
It Date.
91T.EMCEE.
O
Building Permit Application
Pieanning and D.euelopment Services
£'yfd4it31Jl`rz'3fcJim
2��W'Wrg nia Avenue,Fort Pierce FL 34982
Prone.:(772)46:2-1553 Fax;:(772)462=15.78
PERMIT APPLICATION FOR:
PROPQSED,1M, 'R VEM;EI T I O -ATfOI'4.Address-5 rei r--) bq
Property Tax I Q#: L3_01 — &/,3 — e?a 1 7—000 Lot:No.
Site Plan Name: Ayeyd #` Mock%.
Project Name: J: hQrf?X01
DETAILED DISCI JPTIflN OFWORK: :
h eco WAA karVC01
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION - ai
Additional work.to be performed under this.permit—checle.all that apply-
-Wichaftical _Cias'fank _ s pipf _ _Shutters naows/Doors _Pond
_Electric Plumbing `Spprinklers __Generator /1�oof Pitch
Tbtal.Sc.,Ft-of-Construction: SW T Sq.Ft:nf.-irst:Floor:`L _
� 0
Cost'f�a Constru ion:� 1 1 500. Utildf esl. 'Sewer Spofir R!6T no,14ee gt!t-
t WNER/LESSEE. : CONTRA±CTGR:
Name 5hQrexa Name:
Address:&,&o3 bori lot' Rocid Company:�A& lkhyI Ca COV
City: E4. P
Ir r eR, _State: l Addreiis''s--
Zip Code:13 95 Fax: Crty' rn state; II
rnarre No. tjp Code: 3 V Fax.
E-ball: Phone-No 1g G.. / Ft7�'7
Fall in fee sbn* rJtJe'Aolder on next page I if dffferent '--Mail /P
from the Owner listed above) State or County License a,
if value.of.construction.is-25W or more,a RECORDED Notice of CoMmencement is required.
1f valve of HAVC is$7;SM.or more;-a b ED,Notice of Commenw ent is required.
777
aw
UU LE
" .
ENGINEER: Not Applicable M RTGAGE COMPANY Not ApplicableDESIG
Nat~ne: Name.
Address: Address:
City: State: City: State:
Zip: Phon Zip: Ph
'E TITU Not APP icabie I ONDING COMPANY: NotA iicabJe
t rvarrre:.
.:Address: -Address:
lily: ;
one: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has cGmrrsenced prior to the Issuance of a permit.
St,L ucle Coun makes no representation that is granting a permit wilt authorize the permit ho er to builcr the subject structure
whichisir�� Ict with arwa �s3. _po+x *��z���nt9s$#*?R tt �9 `u.4 Y aia ianifstay�yC;L(Yltill (JttfillUtL`SCiGCT
structure.Please consult.with your Home Owners Association and review-your deed for any restrictions w�rhich may apply.
In.consideration ofthe granting of this requested permit I do,hereby.agree that l will,.in all respects,perform the work
in accordance with:tile.approved d plans,the Florida," GWes ap4 St,lwie Courity Amadmvits.
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 Noticee-of Commencement may result-in paying tw0c+e fDr
4nVrovemerft toy. off.,property.A Notice of Caorarnencernerit rni t be recorded in the publicTecords of St.
rude Co rnty and posted on the jobsite ire the f t i s � a i�ynLl r end t�C�bta?� _-eiWb" -aft
with nder or ali attorrA before commencing work or recording our Notice of Commencement.
W /
S nature of Owner/! ss /Contractor as Agent for Owner Signatur C ractorJLicense Holder
STATE OF FLORI STATE
COUNTY OF � U�, COO, OF
Swor to(or affirmed)and subscribed before me of Swor o(or affirmed)and-subscribed beforerne of
V P ical P n or Online Notarizat' P ysical P sence ar Online Notarizat+vrt
this day of ' 2t72f3 .s Ih3ay: 2fl2i3 by
Ili/ � ►► ��I GL 66. says ""°
Name of person making statement. Name of person making st tement.
really",Kn� OR Produced lderiti#ic or3 Per s ally Known OR Produced enti ate X o
Produced FL t.0 i t Produced a 3 =a
N .-a wl �N�/5,
N0gv G� .'3.,Cp
G?N
(Signature Notary Public-State lorida) $ (Signat f No//t��a��ryy+Public-State o rrda} N V~
Commission Na.�r6 -70rf1� (Seal) N Commission No.W.DlbT15 (Seal.}. y
REVIEWS FRONT ZONING. SUPERVISOR " PLANS: VEGETATION SEA TURTLE MANGROVE.
COUNTER. REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.