HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DateC�.I! 1 JI oy� 1 Permit Number:
Building Permit Application
Plannrng and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578
PERMiT APPLICATION FOR:
'0• .� ]ILA• !__
Property Tax I D #: 14
-09
Site Plan Name:
Project Name:
T
i �L.�P �t 1 r�' a
,
Commercial Residential
New Electrical Meer Second electrical Meter
C3 -
Additional work to be performed under phis permit —check all that apply:
'Mechanical _Gas Tank _Gas Piping Shutters
Electric
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ (JI) rv_�
Add
City
Zip
Phone Nv.GCD[-
E-Illlail:
Sprinklers
G e nerato r
1
Lot o.'
Block No.
Windows/Doors Pond
Roof Pitch
Sq.ft. f First Floor:
Utilities: Sewer Septic Building Height:
Fill in
fee
simple
Title Holder on next page (if different
from
the
Owne'r.listed
above)
Name:
I
wl�
Company: ��u."e, `F1 rr;O
Address,-,14&0
City: '5 SL
Zip Code; .:3,9 09_E'�' fax:
Phone No2:2'.- ICQ
E-Mail,..�rujtj:enqoL Lx...,4 (!� sry-.�
State or County License
If value of construction is 2500r more, a RECORDED, Notice f Commencement is required.
If valueof HAVC i 7� 00 or more., a RECORDED Notice of Commencement is required.
L L-C ..
State:
'�
15
DESIGNER/ENGINEER:
_Not Applicable
Name:
Address:
City: State:
ZIP: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip.
Phone:
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
City: 5tate:
Zi P: Phone &
BONDING COMPANY: Not Applicable
Name:
Address:
city:
Zip: Phone.
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated,
certify that no work or installation has commenced prior to the issuance of a permit.
5t. Lucie County makes no representation that is granting a pe�-mit will authorize the permit holder to bu i I d the su�aject structure
which is in cvr�flict with and applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit.such
structure. Please consult with your Hams owners Association and review your died for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that ! will, in all respects{ perform the work
in accorda-nce with the approved plans, the Flori-da Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a fuli concurrency review: room addition's.,
accessory structures, swimming pools, fences, walls* signs, screen rooms and accessory uses to another non -re id nt l use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paving twice for
improvemen
Lucie Count
with lenderl
Signafipre�Owner/
to your property. A Notice of Commencement must be rec rded in the public records of St.
nd posted an the jobsite before the first inspection. If irAend to obtain financing, consult
apt attornev before cammenciw work or recardir r N&ice of dommencement.
ee/Contractar as Agent for owner I 5ignature'Z5fC6ntractar/Lic 'e Holder
STATE OF FLORID V STATE OF FLORIDA
COUNTY OF �i � Gu�-1 E COUNTY' OF 45�
S'worn t (or affirmed) and subscribed before nee of
�} , 'rlr nr rli rye Notarization
th i�' day o v-%- ,202t b
ame of peen making statem nt.
Personally Known
Type of Identification
Prded
OR Produced identification
Sworn to (or affirmed) and subscribed before me of
Physical presence or nl-ine Notarization
this _day f ,by
rye oe,on making statement.
Personally Known OR Produced identlfi@tin
Type of Identification
Tud
i at r # Notary Public- L;� � i �t� r a Notary i�u l F - Y
Comm'ss"on No.
} JAIME ORTIZ V I da
r b0c - State of i" orld F �Notary� -State
I I
Is
commission # GG 228AMCo ission No a 1) Ciommiss
,+� 22
My Comm. Expires Jury 1 , 02 f � �� ��* Comm. Expires. Jun � A
#hF�YI{
Bonded through National NotaIr Assn. Bonded through National Nota rY ssn,.
-pow IM
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DATE
RECEIVED
DATE
COMPLETED
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