HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. .X)
Building Permit Application
Planning and Development Services Perrl i ttu i : g
Building and Code Regulation Division Commercial_ Reside tidit, i_IIr:iP. l.f)1l ty, 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITAPPLICATION FOR: 'Poo L RG No iia? i oN
Address: % d' 1 1 to re a"4 'I s In U r of c-
Property Tax ID #: 341 — spa — c733 3 -- awl 6 Lot No,
Site Plan Name: Block No.
Project Name:
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: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer Septic Building Height
OWNER/LESSE _
CONTRACTOR:- -
:::
Name ljopir,4 T Iq -d .
Name•.
vz:�n�sr,•.,.r :d• ..•.
Company•:�5'•l
Address: N� C
City: state: ILL
Address; ^' ZlQ moy La
City r S Lu r; o Stater
Zip Code: aZ Fax: — — d
Phone Nc ?f2 —4 461
Zip Code: � 4 c.t_i � Fax:
Phone No 3��Ss�(o t
E-Mail_f%
E-Mail: f —;a r. - C,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County Ucense_C pC -L' �;%
it value or consrrucnon is c uu or more, a ntLunutu noace or Lommencement is requrrea.
If value of HAVC is $7,5D0 or more, a RECORDED Notice of Commencement Is required.
�SCO-fV- S�TII�U '-v0 MEN AN1
OE
DESIGNER/ENGINEER: — Not Applicable
Name:
FOR111
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address-
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City: .
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao me worn arm
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 mayapply.
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
.. I r__ — __ -...----.. L_t__.- ___._..-....6.....1-IL, — o1-4i" vrn Mntiro of r ,rnmPnrPmPnt.
Signature of Owner Lessee/Contractor as ent for Owner
Signature of Contractor License Holder i
STATE OF FLORIDA /
STATE OF FLORIDA /
COUNTY OFF
COUNTY OF
Swam to (or affirmed) and subscribed before me of
Sword to (or affirmed) and subscribed before me of
Physica6Presenf��or Online Notarization
Physical Presence r Online Notarization
this 2day of C/� 20 / by
this s' Z day of _: a-t by
f �/,,20
IA42Z(IGC
Name of person making statement.
Name of person making statement.
Known `� OR Produced Identification
Personally Known `� OR Produced Identification
Personally
Type of Identification
Type entification -
Produce
Prod ced
( ignature o aie ic- utyraEidarid n«.a■
Marion R Hogslen
Signa ure of Not P Stdjgrp66 Ng{elda n«a
Mr Com '-Or�y,M]401
Commission l\l , aroe�2o
Macon R Hogslen
Commission No. Mr Commnaon �■�,���01
an o.roa2 d2^F
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE:
RECEIVED
DATE
COMPLETED
HeV.J/O/ZU