HomeMy WebLinkAboutAshtonBurrowsPermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date 3 al Permit Number:
. Ed N�i'0.9
•
BuildingTermit Application
Planning and DeveiopmentServices %
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: T�s-ron 6umw S
PROPOSEQ IMPROVEMENT LOCATION: Address: 5 S o� Fo( r t
Property Tax ID' #: 3 "► G W 73 -- 600— Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTIONDF WORK:
tro
New Electrical Meter 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
Electric _ Plumbing — Sprinklers _ Generator _
Roof Pitch
t
Total.Sq. Ft of Construction: ��T 3 4,y Sq. Ft. of First -Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: F k.
city State,
Zip Code: 3 Fax:
Phone No. -I 72- (D l CY' 5YSC)
Name:
Company:
Address: l
City: State: -Er
Zip Code: �_l Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or iTounty License
if value of construction is 2500 or more, a• RECUXUtU iYonce or commencement is requireu.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: V Not Applicable MORTGAGE COMPANY: il Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name:_
Address:
City:
Zip:
Phon
Name:
Address:
City: State:
Zip: 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.
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, I do hereby agree that I will, in all respects, perform the work
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, wails, 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 Ionrior nr an gttnrnpv hPfnre commencing work or recording vour Notice of Commencement.
Signature {8ws4wssee/Contractor as Agent for Owner
Signa re-e€L7.�ntractor/License Holder
STATE OF FLORlr%A
STATE OF FLORID p
COUNTY OF 0T, L-Lkc,-.e_
COUNTY OF r L_U (A't'
worn to (or affirmed) and subscribed before me of
Swto (or affirmed) and subscribed before me of
.71
Physical Presence or Online Notarization
hysical Presence or Online Notarization
his � day of i�(il�� c 4� 20,2J by
this � day of (Y�,[A1� 202L by
^
ame of person ma ng statement.
Name of person maki statement.
ersonally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
ype of Identification
Type of Identification
roduced
Produced
Y ^.. GERI L CALHOUN
a Public • Sta e f Florida
ignature of Notary Public- State of Florida }
(Signature of Notary Public p -c (emission p GG 916233
j�y"Lomm.
Expires Oct 6, 2023
Commission No. (� U �I t o J3 3 (Sea!}
Commission No. Bonded t u ational Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 6/20