HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ g'2'07_\ Permit Number:
S`n L✓LLL
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential ✓
PROPOSED IMPROVEMENT LOCATION:
Address: �6i) 6✓`��'sm'- f -' 0.
P r o p e rty Ta x I D #:
Site Plan Name:C
Project Name:
Lot No. 1-5
Block No.
DETAILED DESCRIPTION OF WORK: I
Z
New Electrical Meter
Second Electrical Meter
CONSTRUCTION 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: '�y 01-\ 5 Sq. Ft. of First Floor: �o'4s
Cost of Construction: $ a—, q ) LI US Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CG.rI':'S ar`el Tey"i4cr Lit. kS
Name: o\rr
Address: C) aq ) cko
Company: G,yt,� bAk¢c S , G
City: ?0'\" StateF�
Zip Code: '�Hqq Fax:
Phone No.1YL -Li - LP\VW
Address: sV Lvua, %,,ok-
City: V -k Sk. Lv-c i-e State:�r�
Zip Code: �Jg53 Fax:
Phone No
E-Mail: l A'Lwt,%S 0 Gat . f bw`
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail l DAc4 C.'C'�A
State or County License Cif 1 S; 7M ✓
If value of construction is 2500 or more, a KLCUKULU Notice OT 9_0MMenF_emc11L n'cyuu cu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name: L%r L a (fie ey,S
Address: 5lo4 C•-� d Pot, -- v.7aN
City: A)oeA-k Pc�"- ar- State: FL
Zip: 3121 t Phone U�-'k-lqj-D415
-.. -.._ -__-__---------------- -------------------
FEE SIMPLE TITLE HOLDER: \.Aot Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: v+tot Applicable
Name:_
Address:
City: _
Zip:
Phone:
State:
BONDING COMPANY: _j,,N'ot Applicable
Name:
Address:
City:
Zip: Phone:
UwivtK/ LUINI I KAL I UK AFFIUVI I : 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 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 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 or an attorney before commencing work or recording your Notice of Commencement.
Lire of Owner/ L($see/Cda0actor as Agent for Owner j Si� ature of Contractor/ i ense Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�u(_� e— COUNTY OF S+1.lA
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this-?) day of -by
2oz t
5wor to (or affirmed) and subscribed before me of
YPhysical Presence or Online Notarization
this g day of JCQ)tAQg:�j Wit) by
20Z1
Gtn n 'S m Z cA �7rVtn �.na-yLOn Lit C, rot 0,
Name of person making statemen . Name of person making statern nt.
Personally Known OR Produced Identification _ Personally Known �_ OR Produced Identification
Type of Identification Type of Identification
Produced_ Produced
(Signature o tar Pu lic- State of Florida )
q i ; , :. , (Sigrature of No�ryPblic- State of Florida )
Commission No. ��...,/�,�� I �J� Seal l ��-� ��� (Seal)
—L�� ( ) Commission No. )
- - - - — -- -- -- .......... j
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED