HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BI COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,q 7- Permit Number:dZ 7�� y ��
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Building.Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division COI'YlmerCial Residential
2300 Wrginla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553,Fax-1(772)462-1578
PERMIT APPLICATION OR: <, nzC
PROPOSED'IMPROVEIOENT LOCATION:.
Address: - , 3
PropertyTax.lD`#:> 5 I`i a'�T rJ (1af 000 Lot No.
Site Plan Name: .�i A/,14 c-,/:,? Block No.
Project Name:
DETAILE'D..DESCRlPTlO: . -OF WORK:
i' e IV- QAJ 4L/0
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be perfor ed under this permit-check all that apply:
Mechanical =Gas Tank ^Gas Piping _Shutters _Windows/.Doors _
Pond-Electric —'Plurnbing _ Sprinklers Generator Roof: Pitch.
Total-Sq.Ft of Construction: I Sq.Ft.of First-Floor:
Cost of Construction:$ 6i2o0 �r'i Utilities: _Sewer _Septic Building Height:
01NNEfi%LESSEE: CONTRACTOR:
Name OAPAJI kL A A.t Ir UL+AvA S Name-.. ij A:&,;�, /% : C,( 1 5 jam_
Address: 30/1 ' fl Lt Company: a;L--+ 5
City: T.(T -State, Address:
Zip Code: Fax: City: �� �S State. �y
Phone No. `7"7 2 Z '0 soZip Code: V- 2, Fax*
E-Mail: Phone No -77 2,, Z /.6 53 q- 4
Fill in fee simple Title Holdey-on next page(if different E-Mail ��`L i ��' l tri. ✓`v.e mil.j.,
from the Owner listed above) State or County License 7- 5'J i 3
If value of construction is 2500 or more,a•RECORDE Notice of Commencement Is required.
If value of HAVC is$7,500 or more,a RECORDED No ice of Commencement is required.
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I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESiGNERANGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: I '�
Address: Address:
City: State: City J
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 ork'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 holde to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants t iat may restrict or prohibit such
structure.Please consult with your Home Owners Association*and review your deed for any restri_tions 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.,: .,.. � .0
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendme ts. ;. 4^=%=.:;tc:•, , r
The following building permit applications are exempt from undergoing a full concurrency review:�room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to an ther non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resul in paying twice for
improvements to your property.A Notice of Commencement must be record d 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 recording our Notice lof Commencement.
Signature of Owner/Lessee/Contractor Ws Agent for Owner Signature of Contractor/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
i/ Physical Presence or Online Notarization 1/ Physical Presence or Online Notarization
this day of F. .20J I by this�day of � • !!I I .2031 by
I
Name of person making statement. Name of person making state) ent`.
Personally Known OR Produced Identification-0 Personally Known Oft Produced Identification_ X0
Type of identification Type of identification J
Produc fibL- Produc (::Cb(—
Moa-turh of Notary P bliic�Stature f E Si re of Nor*17COm
il:}RODRIGUEDid
In
YA ODRIGUEZ ARIAS - ry Public,State of
$ Nota Pub' ,State of Florida GG 33Commission No. Co n#GG 335182 Commission No. ( 6[VMy comm.expires May 15,2023 mm.expires May 1
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