HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O R.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
J
PERMIT APPLICATION FOR: , r.l�, L �' 1 Q4Ion
PROPOSED IMPROVEMENT LOCATION: .�T
Address: 0171 �� -,Trl r- G CA
Property Tax ID #: `'J - n-, Lot No.
Site Plan Name: G r ; "I - Block No. _75_
Project Name: c .
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Efectrical Meter
I 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: Sq. Ft. of First Floor: _
Cost of Construction: $ !2-)On . 00 Utilities: -Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam i
Address:
Name:y-ownta in
Company: ,
City: State:N_
Zip Code: Fax: -
Phone No.
Addre :
City: State
Zip Code: Fax:
Phone
E-Mail
E-Mail: �-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County LicenseNIA
C50
11 value ui wnbLruLziun is cwu or more, a rcewrcur.0 Notice or commencement is required.
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
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:
UWNtK/ LUN I KACTUR 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 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.
Signature of Owner/ Lessee/Contractor as'qent for Owner I Signature of Contractor/ icense Holder
STATE OF FLORIDA
COUNTY OF <. - I
Sw�n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
th— isIX4 day of TGn ZpZB by
_' �hv u n I 1�, -A+
Name of person making
/statement.
Personally Known v OR Produced Identification
Type of Identification
Produce
(Signature of Notary Public- State of Florida )
Commission N�19('�LoS (Seal)
REVIEWS
EW REVIEW
STATE OF FL IDA�4
COUNTY OF�t. t'�
Swq�n to (or affirmed) and subscribed before me of
y P�iysical Presence or Online Notarization
this day of'7Ajn . 20i6 by
VZl
Name of person making itatement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. ,C i (V3 (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE ;' `1• �73
RICHY GO ES, RECEIVED JR.
DATE rr
COMPLETED - —J =' '= CO tmission !t GG 966763
_. _ ''',?�.. °�� My Cwnrnisson EXPirts
Nctary Public•State of Florid
commission Of GG 966763
My (k a •hiSvinn Frnirae