HomeMy WebLinkAboutPermit App For Shed_4501 Orange AveAil APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
-%1r. Loa
O
17 Building Permit Application
Planning and Development Services Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 344$2
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: S N 60
PROPOSED IMPROVEMENT LOCATION:
Address: 50
Property Tax ID #. 2 Q0
Site Plan Name:
Project Name:
w. a I 9,., r,ect'DioTlnhl of:- WinRK:
Lot No._--- --
Block No. j_
r
New Electrical Meter ^ Second Electrical Meter
li t �tWN INMRMATION: '-
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: �' S Sq. Ft. of First Floor:
Cost of Construction: $ Z2 0 0 Utilities: —Sewer _ Septic Building Height:
CONTRACTOR:
I Name s' 3 Name: • Ae / r
! Address: (S Company: G1. �
City: State: � Address: Q 05
Zip Code: Fax: City: �G
Phone No. Zip Code Fax:
E-Mail: M n+- Phone No 2 - 7,
IP
Fill In fee simple Title Holder on next age (if different E-Mail +� •
from the Owner listed above) State or County Licenser
I value of construction is 25W or more, a RECORDED Native of Commencement Is required.
value of HAVC is $7,5W or more, a RECORDED Notice of Commencement is required.
State:...,/
NY_
,gnned wilh CamScanner
VIERTA
'C(jNSTRUCT��N LIEN LAW INFORMATION:
wr-Jm'%t:K/ENGINEER:
Name: Not Applicable
51
Address: r
C.tty: 0 State:
23p: Phone 40- to -
FEE SIMPLE TITLE HOLDER: C-Mot Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:—Iwlot Applicable
Name:_
Address:
City: State:
Zip: - Phone:
BONDING COMPANY: tz;r' of Applicable
Name:
Address:
City:
Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as Medicated
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lude Count makes no representation that is grantinga permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home owers Association rules, bylaws or anti covenants that may restrict or prohibit such
structure. Please consult with your Home owners Association and review your deed Tor 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 additionm
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 Notke of Commencement may result In paying twke 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 attornev before commencing work or record)n& our Notice of CommenceWnt.
Signature of Owner/
as Agent
STATE OF FLORIDA 1COUNTY0F
STATE OF FLORIDA
COUNTYOF 4• - { q;1- d «:eN Rleye-
Sw9rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this M day of 2l}IO
Name of person making statement.
Sworn to (or affirmed) and subscribed before me of
. Ph r��rssicaI Presence or Online Notarization
this `-day of 20
�a ,a,,
Name of person making stirte0jant. 1
Personalty Known OR Produced tden
i6on Z
Personally Known OR Prod on
_
Type of Identification
o 00
Type of identification t
Produced
3 j. 2 ,
Produced,
7- M' 2:
n.
7 f�l
(Signature of Notary Public- State of Florida)
o ; �Q' z
O f R
(Signs Of Not I rida) G
•/
Commission No. (Sea!
Y N N
M ti o �
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�IjGrT(i'y77 R7
Commission No. /}(i�7�D t � Seal
((Seal)
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REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
FREVGETATION
SEA TURTLE
MANGROV
COUNTER
REVIEW
REVIEW
REVIEWIEW
REVIEW
REVIEW
LIFTED
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