HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dace: Permit Number �06.1, �
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9 ` �'� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: —1
$"PR0F' VLED1 'RO /�M NTLOC ® I _
Address: 2 H '�o"IyLA V,A
Property Tax ID#: A L4 d� (33 lsQ l 000 0 Lot No.
Site Plan Name: Block No.
Project Name:
DETA QED 3: fi T s®N O� $ K —
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New Electrical Meter Second Electrical Meter
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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: Sq. Ft. of First Floor:
Cost of Construction: $ 21 285, ov Utilities: -Sewer ^Septic Building Height:
15001111ELESS�� ` � jCQ: TRCTO PIS � �k =r ;.-' =
T ..��. ,►e. �k1�z ,. ram...
Name -riczz ';t:% Name: fv�P_vlPli /Y)4JJG4'i.5'
Address: l2L �W �y� a.ti �'Ve Company: P -P elnGC
City: PS L State: 710
_�(., Address: � [!OdGv{ C�✓�G _
Zip Code: 3445 3 Fax: City: III ' Stater
` Phone No. (q Sy� �21_ 7�to Zip Code: 3 qq4 5 Fax:
E-Mail: Phone No � Q�C)7j
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
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.
,l•'1 (Vt��x'� O'N� RU- F "`��I: CA- LN:�� R; � �.�
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
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 installatinr, has commenced prior to the issuance of a permit.
St. Lucie County makes nor tion .:t is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any �iic,. ��e Hone Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult W' ,our Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grar g of this requested permit,I do hereby agree that I will,in all respects, perform the work
in accordance with the appivved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency revi . room additions,
accessory structures, swimming pools,fences,walls, signs,screen rooms and accessory usenother 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
it lender or an atWrney before commencing work or recgrding your Notice of Commencement.
gn ture of Owner Lessee/Contractor as Agent for Owner Signature of Contractor -icense Holder
STATE OF FLORIDA STATE OF FLORIDA / J
COUNTY OF S�' 'U6k1f COUNTY OF \
Sw rn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presenc r Online Notarization Physical Presence_.pr Online Notarization
this f 2 day of 202 f by this j�? day of E 0 1�5— 202pf by
Name of person making statement. Name of person making statement.
Personally Known X OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
IProduced Produced
nature of ary ublic S' nature ota Public-State of lorida�jl��jlill',,IFER SMITH
RSOTARY pUBNOTApy pUBLIC all-1 L{(p� E OF FLORIDA
Commission No. STA FLOR 7 IDA Commission No.
NO.HH7484 MYCOMMISSlON0.D(pl�
MY COMMIS p
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
Vv
ATE
OMPLETED
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