HomeMy WebLinkAboutBuilding permit application+'CAI APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED 3v✓Dr�JC9
Date: _-t.'c*Z- 4---- n Ojai"
Permit Numtxr, ��--i---
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c `` Building Permit Application
Planning"i)''YeioPatent Sefvtces
' u"d"V artd Code Regulation avlslon Commercial --
Residential
2300 Virginia Avequr, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462.1578
PERMIT APPLICATION FOR: M(,� SLf}b
MFNT I nrATlnN-
Address: '-��+r�-a Cn l��L A n - -
Property Tax ID # l ] -�6A n(4 - O-e A - OfX)' Lot No.
Site Plan Name:
Block No.
Project Name: c1mr," , o S L11 & - -
New Electrical Meter Second Electrical Meter
(CONSTRUCTION INFORMATION: 11
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: "�iArSq. Ft. of First Floor:
Cost of Constru+ctinn: $
2„ /5'00 , Utilities: Sewer _Septic Building Height:
i' vuwER ff7E �' !-� _ - • . .. - -- I CUN I KACTUR: i
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City
: t b r a * yy Mate:
111p Cade. 3 4R5" 1 Fax:____,_. }-..__
phorw No.
f-MaN:
FW W ter *r4* Title N0kW on next pike j If different
Imm tm Owner WAd Abm)
Company:
Address: 1 q
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City: %7 , �' f ' L ui e State:
Zip Code: g,�_ Fax:..
Phone No 3
E-Mali i
State or County License C-rzDZ (a((
ff wlw of j—v ctlon is ZW or mm, a RECORDED Notks of commmen ent is required.
K V"W N NAVC if 67AN of 0", a iiECOOMO Notice of camnwnconent is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
ORTGAGE COMPANY: ---
Not Applicable
M
Name:
Address:
City:
Zip: _ _ Phone:
FEE SIMPLE TITLEHOLDER: ____ 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 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 sub)ect 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, walls, 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, consu�t
with lender or an attornev before commencing work or recording vour Notice of Commencement.
as Agent for Owner
STATE OM
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
h sical Presence or Online Notarization
this day of r'r1Q 2020 by
Signature
STA
COL
Swop to (or affirmed) and subscribed before me of
Ph sicai Pree or _ Online Notarization
this day of _sencarr 202# by
_-'DA- "i1'PA X, b ca /AQ (L � nifp r 17 A (C
Name of person making statement. I Name of person making statement.
Personally Known OR Produced Identification�Personally Known OR Produced identification
Type of IdentifiG�on � Type of Identificati t )
�ttduc.d-T=E -- ��'�• i .i2 fZ f t t IA j. + Produced r'L_�
(Signature of NdQry�ubi to �en>e� ature �r o-StetL�of Florida }-- f
NOTARY- BUC Colleen Demers i
Commission No. STA I O Commission No. NOTAR�ft*Ic
C&MOG,Otgp463 =STATE OF FLORIDA
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