HomeMy WebLinkAboutPermit App 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
(\a
01`
.,... Building Permit Application
Planning and Development Services
Suilding and Code Regulation Division Commercial Residential
2300 Virginia A venue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax I D #: 3 3 �-7 -- Z-0 0 - % Lot No.
Site Plan !Name: rf/ A Block No.
Project Name: .K, , ,c �<
New Electrical Meter Second Electrical Meter
Additional work to be performed
,,.._Mechanical
Gas Tan
under this permit -check all that apply:
k _ Gas Piping A Shutters
___. Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name �1�2 i `
Name. -7-10.rn4'C
Aciclressd 3 3 5 u n C,'
Company: COgt ,, i e/.,
City F S L State: FL-
Address: 6,236. itSvc: r �CiLvtr'.
Zip Code: 3���6 Fax-,
City: eer ."..'.
r• State: rl
Phone No.T 7 r- L7
Zip Code: 3 N 9 f1,b Fax: 7 2.7- y` I-jJ
E-Mail:
Phone No 7? • q6 -al
Fill in fee simple Title Holder on next page if different
E-Mail TO 'C Q VA&CO " G 000
from the Owner listed above)
State or County License,se J a] 1.C/S"0
fr value W 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.
Name:_
Address:
C•t
—X Not Ap
y' State:
Zip: Phone
e
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone
4 Not Applicable
te:
Name:SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: 4Not Applicable
Na
Address: Name.
City: Address:
Zip: Phone: 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 lender or an attorn before commencing work or recording
our Notice of om encement.
ature
ntractor as Agent for Owner rs nature of Contr ct /License H
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A . L7 C-Oc COUNTY OF :2A -
Sworn r affirmed) and subscribed before me of Sworn r affirmed) and subscribed before me of
hysrcal Presence or Online Notarization hysrcal Pres nce or Online Notarization
this day of 1 20W by this day of L, b
2a � 2� zl y
Dame of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro dLri DQiv�p Lj Produ 1k �i cEyl
ignature of N ry ubl' of Flori
bi-IrMt- of Mot Pu ic- F&6fi4FIorida )
;'a;' ORLANdO VA
Commission No mot'".-,''�`:. tic -St CommisSi n, . ��"--, � QRLANDOrJAZI�UET
Commission 4 GG 18%41 o a tc raEe of Flarld S i)
zip. My Comm Expires Feb 26, 2=
Comrnission GG 189841
REVIEWS Z NING SUPERVISOR PLANS Bondedthra�ghhationaiNotaryAssn.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW MANGROVE
DATE
RECEIVED
DATE
COMPLETED