HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Sm. C iauL
1=12
V. G 0 L-l? i; -—
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 3—--
Phone. (772) 462-1553 Fax: (772) 462-1579
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: c�-,
Property Tax ID #I: �d
Site Plan Name:
Project Name -
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
V,I
d ` (14, )
Lot No.
Block No. 3.
WCU
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:
Cost of Construction: $
Sq. R. of First Floor: —
Utilities: — Sewer — Septic
Building Height:
OWNER/ SSEE:
CONTRACTOR:
Name
Name:
Address:
Company:
City: �Y C� Stater
Address: 1
Zip Code I Fa
City: State -FL
Phone 111a.
Zip Code: X;4lAq„ lq.ttn Fax:
E-Mail:
Phone No-1 � — 4S 3 ` yo�l,
. —
Fill In fee simple Title Holder on next page ( if different
E-Mail n'11 1
from the Owner listed above)
State or County License_
.o...F .,a....ti,,.,. n team ur -a—ce - n—unury wolaw or commencement is requires.
If value of HAVC is $7,500 or mare, a RECORDED Notice of commencement is required.
�SUPPLMrAcolsTRUC ION'l N' iiESIGNERf ENGINEER:
Name: Not Applicable
Address:
City:
Zip: Phone State:
FEE SIMPLE TITLE NOLDDER:
Name: Nat Applicable
Address:
City:
Zip: --�. Phone:
MORTGAGE COMPANYc
j Name: Not Applicable
Address:
City:
Zip:Phone: State:
BONDING COMPANY: Name: —Not Applicable
Address:
City:
ZIP: Ph
one:
OWNER/ CONTRACTORAFFIDVlT; ApPlicativn is hereby made to obtain a permit to do the work and installation as indicate
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County p d-
which is in Please
with anrepresentation plaeaO�wneastAssoclation�rules, bylaQws ur and Covenants that may est subject structure
structure. cease consult with your Home owners Association and review your deed for an restrictions which may apply.
In consideration of the rantin of this re wasted y y r prohibit such
in accordance with the granting 9 Permit I do hereby agree that 1 will, in all respects, perform the work
pproved 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'TQ OWNER; Y failure to Record a Notice Of Commencement may /q6sud
paying twice far
ucie verttent to ya r }� aperty. A Notice of Carnrrrencement mu a rein the public records of 5t.
Lucie Count a p ted n the Jobsite before the first inspectio . if ou d obtain financing, consult
with lender ra am before cot�mencin work or recorrlin ,1.. t U_s n _..
Signature of nerJ lessee Cora ar a Agent for Owner
STATE OF L RIDA
COUNTY F GYM 1 k `.e_ 1t9
Srgrn to ( a firmed) and subscribed before me of
Physl reser�or Online Notarization
thiZs 1 day of 202P by
+�r ct Y p
Name of person making statement.
Personally Known --.-OR Produced Identification
Type of Identification
t-•e; •��W+W U, 140131ay Public; State of Fl�`o � �ON
Commission No. . ......
9,y
JN
•. �, .
REVIEWS A
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FRONT 1 IISOR
COUNTER RBI ,%/t=%Ar
Signature
STATE
Sworn toVala,
irmed) and subscribed before me of
Paysese r Online Notarization
th s Ljd 202N by
Nam�ofplrson
making�Stltlm�ent���.
Personally Known __k_ OR produced Ide ti cation
Type of identification
Produced
{ !gn ure Nata
+Notary b€iCc S>aie of Ffaritla
Commission No. Karl M�I
a OSM024 °7sas
PLANS VEGETATION SEA TURTLE MANGROVE
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