HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. permit plumber.
1z"'IL- 'k �Y. U 107
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Building Permit Application
Pla nrr in q and Develop m err t Setvices
Building and Curie Regulotlon Divi ion �l'�"1t�er�l�� Residential
23 00 Virglnis A venue, Fort Pierce FL 34982
Phone: (77 ) 46 -1553 Fax: (7) 4E -157
PERMIT A PPLl CATI 0 N F 0 R:t44 rq C' N C
PROPOSED IMPROVEMENT LOCATION:
Address: "3 1"1 D YFk�--N1 M�
Property Tax IQ #:
E
I - 0 1 Oz.- 000 -
Site ''Ian Name'n E_ Gr�
Project Iatne:
eucTLer,
TAILED DESCRIPTION OF WORK:
Rr-
PC, 0
New Electrical Meter
I i 1'P4 G Lc..r
r I bnl�
second Electrical Meter
CONS.TRUCTION INFORMATION:
€ ditional work to be performed under this permit - check all that apply.
Lot No. L( 9 11
Block No. S
FT
Mechanical Gas Tank „Gas Piping _ Shutters , Windows/Doors ,Pond
Electric � Plumbing � Sprinklers _Generator /Roof Pitch
Total Sq. Ft ofConstruction: q. Ft. of First Floor:
Cost ofConstruction:
DWNER/LESSEE:
Name
Address:
City:
Rf L{oa . as
Utilities: Sewer _ Septic
state: FL -
Zip Code: Fax;
Phone No. — —
E-Ma-11� m, r1tJ4 r2.60M E�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
l
Building Height: 2-11
rt LIOMR W
Address: 7.511 NW Sr S-C
City:�A���+l"��- 5#ate: Ft --
Zip Code,. 7730 9 Fax:
Phone fVn el S1f—
L4 S _S -777 9
E-Mail LC-'P At=_J4�-r
State or County License Cc-c_ ?2,6 It /a.,
if va lue of constru a ion 1s 25 00 or more, a RECORD ED Notice of Corrrrx encement is required,
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
r_ K1 A linable
DESIGN ER/ENG I NEER:
Not ApplicaUle I M0RTUA(3tL,.UM MART: Via
Name:
Address: Address:
State. City: Mate'
City: f Phone
i P boA
F E E SIMPLE TITLE HOLDER:
Name:
Address:
City:
ZIP: Phone:
Not Applicable
BONDING 0MPANY:
Not Applicable
Name:
Address: -
it:
Phone:
OWN ER/ CONTRACTOR FFID IT: Applicatien is hereby made to Dbtain a permit to do the work and installation as indicated.
I certtfV that no work or -installation has commenced prior to the issuance of a permit.
s no representation that is granting a perrfi-r it will authorize the erm it holder der to build the subject structuresuch
St. Lu�eut marciat rules, bylaws o an covenants that rr�a{ restrict or rohib
which is in conict with and applicabte #rlorr�e rye Y � for restrictions which may �����.
structure. Please consult with your Home Owners Association and review your deg any
consideration of the ranting of this requested permit, I do hereby agree that I will, in all respects, perform the orK
n c��� �
in accordance with the approved plans, the Flofida Building Codes and St, Lucie County Amendments.
The follow-Ing building permit applications are exempt from undergoing a full concurrency reviews room additions,
accessory structures, swimming pools, fences, waIIs, signs, screen rooms aqd accessory uses to another non-residential use
WARN I N G TO OWN E : You r fa i lu re to Kern rd a N otice of Co m men torment ma y resu It in pay! ng twice fo r
improvements to your property.Notice oCommencerat must be recorded in the public records of tLucie .
County and posted on the ' o b ite before the first inspection. If you i mend to o to i n fi nand n , cons u It
with le ad e r or a n att before com men ce r work r r cord i r cu r I tice of Commencement.
Signature of Own Lessee/ onkractor as Age for Owner
STATE OF FLORIDA,�ALM.e 6 4, 1
COUNTYOF
r n to (or affirmed) and subscribed, before me of
sical Presence or online Notarization
Ph
this day of ,40-:�Y
ir J
Name of person making statement. '
Personally Known R Produced Identification
Type of Identification
Produced
( lgnit r� of Notary{ Public- Sta
Cammission No. firklo
'At I $jet GALE E L
#` tart' P title- t8*9 u
R i GG I
May W: 2021
Signature
ontr~actor/License Holder
STATE OF FLORID
COUNTY of
�to (or affirmed ) a rid su bscr-lbed before me of
Ph sica l Presence or o nl 1ne Notarization
t
this day of
-�J
Name of person maki
ng me rat,
Personally Known Produced Identification
Type of Identification
Produced
�ture &f Notary Public- State -of Florida
I
Piro
Ar
ie r 4PubUe Staled 4
E M71 COMMMIW HF106
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA'fUFtfitE 1 MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVES
DATE
COMPLETED
e, 576/20