HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BEQ COMPLETED FOR APPLICATION_ TO BE ACCEPTED u
Date:.: f� q`1510121 .I Permit Number: i����� 1Co
RECEIVED.
Building Permit Application J1 /epo"urnttmy
Planning analDevelopmentServicesent
Building.and Code Regulation Division Commercial Residential St'
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772).462-2553 Fax: (772)462-1578
PERMIT APPLICATION FOR: C I S
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Address: ( j ss I^v r -1 (i{� � 5D �• ��
Property Tax ID#:-9 0's' I Lot NoT
Site Plan Name: ru-z-q 1-Drums- Block No.
Project Name:
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New electrical Meter Second Electrical Meter
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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: -Utilities: - Sewer =Septic Building Height:
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Name_ �• Y Anz J� L v$;Nam:e.•..,.:.�.,.:;._ .
Address:')—PO ouu AJA l Gr licompany:
z
City: en Ct.�L State:�L ;Actress IOU°' :' `}� ' 'b';•-:` `u
Zip Code: L Fax: City'"` <a: .,4;. >, •::u< 4:F ? State:
Phone No. �7�--�7(�7(C(� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or.more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
rDESIGNER/ENGINEER:. Not Applicable MORTGAGE COMPANY: —Not.Applica!Wq.
Name:
Address: Address:
City: State City: State
Zip: Phone Zlp: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not;Ap;p1ic;ab71eq
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.
I certify.that no work or installation has commenced-prior to the'issuanceof a permit.
St_'Cucie Count . kes no,representation that is.:granting a,permit will authorize the,permit holderto build the subject structure
which is in conflict with any applicable Home Ciwners Association rules,bylaws or'and,covenants-that may,restrict or.prohibit such
structure.Please consultwith,your Home Owners Association and review your deed for any restrictions which may'appiy.
Inconsideration of the granting of this requested permit,]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.
J.
The following building permit applications are exempt from undergoing a full-concurrent}%review:`rooin additions,
ry accesso 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 yout,property:A-Notice of Commencement must be recorded.in,the public reco.rcls•of,St:-
Lucie;Countyarid posted on the jobsite before'the first inspection.ifyou.intend to.obtain'financing;consult
with lender or an attorne' b'efore•commen-ein 'work o:r_'tecordin our Notice of Commencement.':,•,
Signature of Owne /Lessee c ntractor as Agent for Owner Signature of Contractor/License Holder•.;:
1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S LUCf COUNTY OF
Sworn-to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
.Z Phy icA Presenceor Online Notarization . Physical-Presence or Online Notarization
this 2day of--:Q0nVCUi 20 4/'by this day of 20_ by
G't e ' c'�CiC�S Of!
Name of persloi making statement. Name of:persori making statement.
Personally Known V OR Produced Identification Personally Known OR Produced Identification
` Type of Identification Type of Identification_.
Produced Produced-
(Signature cf Notary' "gL (Signature of Notary Public-State:of Florida)
FAY
s Commision No.
'*' *_ F AAA Commission No. (Seal)
•°. • 40.Bp�dTrwTiopFaN�neg10lE1iST11� •
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW '
DATE
RECEIVED
DATE
COMPLETED
Rev.53/6/2