HomeMy WebLinkAboutSMITH BUILDING APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 49o? - az? •a/
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78
Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7—WI;7 OA/YS T L FoR T Aleler6- FG el 9�5-
Property Tax ID 4: _e?3,7,1 —y/? — oaa6 -- UOD• 8 Lot No.
Site Plan Name: -,IEFF 9! lg4�e�K S/nl 77/ Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
OF C-is G{>L l0elmie 54C 6/ --0583
New Electrical Meter _2�0_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
II/Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 7vg9 Sq. Ft. of First Floor:
Cost of Construction: $ Jy/, 93Q. Utilities: —Sewer — Septic
Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name ��- /
Name: / 'kW F1,51,7 //J
Address:
Company: e!e 0/
City: FoRr P/etee e. State: F'L,
Zip Code: 3qqq.5 Fax:
Phone No. �%�ai " $.�J
_Ogq
Address: 7035 .sE �%%DiTtCrY_i� ��-
City: `TG1f�,Q7— _ State: FL
Zip Code: 3 W,?Y Fax _%r%� �y%951el
Phone No % — 7.5151
E-Mail
State or County License
E-mail: ftll /horn /a&Jpa ZIn
. �G]/il�l,�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
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:
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 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, 1 do hereby agree that I will, in all respects, perform the worst
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 ! rider or an attorney before commencing work or recording our Notice of Commencement.
Sign to e o ner/ Lessee/Contractor as Agent for Owner
Sign atur c r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF__ ' %1%e7_//7
Swor o (or affirmed) and subscribed before me of
Ph i I Present r Online Notarization
this ay of 202/ by
SW (or o (or affirmed) and subscribed before me of
Physi J Presence or Online Notarization
this —day of 207f by
/ �+
_ _ 14ek q4F/Gm1qr7
Name of person ma ' g statement.
Name of person making statement.
Personally Known OR Produced Identification L--""
Personally Known L.'�C)R Produced Identification
Type of Identification
Produced_
Type of Identification
Produced �r
(Signature f Notary Public- State of Flori a)
(Signatu of Notary Public- State of FFllorida
ComLnission No. oR&a% (Seal
Commission No. e55a �0 (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
M NGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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