HomeMy WebLinkAboutBuilding PermitAll APPLICAB E IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�51r-
O
Ln7 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia A venue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: T-40A obmorff9 tai c R. PI Cd7r FL 34I 1a I
Property Tax ID
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
Ad onal 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:
Cost of Construction: $ ��� 76 r Go
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
{P
S Yt S
OWNER/l�ESSE
i
Z-owes
Name
Name:_ Wes
Address: iq%)- ��ywi{'
_
Company: f"H^�'S�t'u�is�
City: C.,`( State: rL
Address: 3dZJ N 144." W
Zip Code: BSI Fax:
City 4"J ; i!r[
State:
Phone No. '772 -- 3•70- 6VX)
ZipCode:_ ?''�)'' � Fax:
E-Mail:
Phone No 7 7/1- 'LlO 1 _ if7it
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License — o 0
.. _.,.— - a vnaalmb wit iJ C-OUV V1 nwM, a l[C4VKUCu [MOTICe oT Lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I
SU''tEMENTAIdNTC1'IfJkliW'IiVORMATIOT
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DESIGNER/ENGINEER: ^ Not Applicable
MORTGAGE COMPANY:
__ _Not Applicable
Name:
Name:
Address:
Address
State:
City: State:
City:
zip: Phone
Zip: _ Phone:
FEE SIMPLE 'TITLE MOLDER: Not Applicable
BONDING COMPANY:
__.Not Applicable
Name:
Name:
Address.
City:
Address:
City:
Zip: Phone:
Zip: Phone:
A +1,
--L, nnel inctnllatinn as indicated.
OWNER/ CONTRACTOR AFFIDVIl 1. Application is nereoy maue to wLati I a N=„—. -... -..
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structurin e. Please consultwith your Home owners Associa ion and review fr acovenants
y restrict that
which may or
pply obit such
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 OWNiElt: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Its YOUR BAYING
TWICE FOR IMPROVEMENTS TO YOUR pROpERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU pNTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATyORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S' ature of Owner) Lessee/Contractor as Agent for Owner
STATE OF FLORIDA a
COlIeITY OIF - e. e e e e.
The fnr wining instri.imc-rit waa acknowledged before me
this+day of41 2D�..l by
rAvI'?5
Name of person making statement.
Personally Known,'�< OR Produced identification
Type of Identification
Produced
Notary Public- State
'I"' .,, (S&VIAN MONTENE=GRO
Commission No. �*: My COMMISSION 9 GG 069
_r
=�. .._ FXP1R€5:Ansii2.2021
REVIEWS I FRONT SurtKV1Z1
COUNTER REVIEW REVIEW
DATE
RECEIVED
M PLETED
Si ature of Contractor/License Holder
STATE OF FLORIDA
COI. NTY O1F_ _— - —
The forgoing instrumentwas acknowledgeci before me
this Z5 day of -�` -1 20by
Name of person making statement.
Personally Known )< . OR Produced identification
Type of identification
Produced
of Notary Public- State of Florida )
No. _ ; , s Pz' Sup. adf7N I LNt-sltu
My COMMJ$SION 0 GO 089099
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N5 I VEGETATI
REVIEW REVIEW REVIEW REVIEW
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