HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z� ZbZ Permit Number: e�- i ()
�Lo LL UCUE R
Building Permit Application
Flaming and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (77 ) 46 -1553 Fax: (77 ) 4 -157
Commercial
Residential
PERMIT APPLICATION FOR: `bAN j CNN l �' V-0 oN
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTaxiD#: 2-1411�_1007_ d027-000 --
Site Plan Na me C o i2-TP,7-- �•rC"�4i'F._I` UN ('7
Lot No.
Block No. Cr
Project Name:
DETAILED DESCRIPTION of WORD:
V ,
p F P L,,,A-7 t� c) r
tA L �L t
It. LEI'' C) ti 4L0 -
ov R- -1 �6TKL FLA - C �V
New Electrical Meter Second Electrical deter
CONSTRUCTION INFORMATION:
Additional ork to be performed under this permit- check a I I that apply:
!Mechanical Gas Tank T Gas Piping : Shutter
Electric _Plumbing _ Sprinklers
Total 5q. Ft of Construction. 2-
Cost of Construction: $
OWNER/LESSEE:
Generator
T Windows/Doors Pond
ZRoof �'L- Pitch
q. Ft, of First Floor:
Utilities: Sewer Septic Building Height:
CONTRACTOR:
Name: F
Name LLL
Address:COTI?WZ- - WAq Cora pa n : r R(:)Lt�ti
city: W. State: F Address:-2-VI tqW Sar T-r
Zip Code: .._ Fax: City.. A N(IT _ tete,-L-
TtPhone No., *---F i p o+de; - Fax -- - -- --�.��
E - M a i 1: Cb L.L.-F," -, Yr. k PLO AD Phone No Ct
Fill in fee simple Tittle Holder on Bret Rage (if different E-Flail M A `0 Am-r # Cr-T
from the Owner Fisted above) State or County License � �` � �
if value of construction is. 2 500 or more, a REC RDED Notice of Comme cement is required.
If value of HAVC is $7.,500 or more, a RECORDED Notice of Commencement is required.
A
1SUPPLEMENTALh UPPL ENT L N TRUCTI l LIEF LAW I �I �
DESIGN E EN -1 EEIS:
Name:
Address:
City:
Zip: _
Phone
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: � Not Applicabie
Name:
Ad d re s
City: -
iP; Phone: —
MORTGAGE COMPANY. Not Applicable
Name:
Address: -- ......
City: —State..
i Pi Phone
-
BONDING COMPANY: Not Applicable
Name-,
Address:
City;
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applir-ation is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or instal lation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit bolder- to build the subject structure
which is in Corti act with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please GonsuIt with your Home Owners Association and rev!ew your deed for any restrictions which may appiy.
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 concur'rency review: morn additions,
accessory structures, s i-mm ing pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR NIf4 To OWNER; Your failure to Record a Notice of Commencement may result iin paying twice for
improvements to your property. A Notice f Commencement rnust 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 att ire before corn men cing work or recording you r Notice of Co mm encement.
Signature ofrnr Lesseeontractr s Age for Owner
STATE OF FLORIDA.,
o I TY F
S n to (or affirmed) and subscribed. before me of
:7 Ph sical Presence or Online Notarization
this day of AMj %-.. 2,61L t 4i)20—by
Name of person making statement. �
Personally Known - - OR Produced Identification
Type of Identification
Produced 7- L.,.
(Signature of Notary public- Stat
i�
Commission No. Sri - _ L +�
Signature oContractor/Cicense Folder
STATE of FLORIDA
OUNT OF
v�r to (or affirmed) and subscribed before rare �f
Physical Presence or _ Online Notarization
this day of �-� by
Name of person makin
gment.
PersonalfV Known Produced Ident[fication
Type of Identificatinn
Produced
-GALE ANN NE SURLure 7f Notary Public- State of Florida
I
tare Public- ta*a a Flpfidai
Commisslon#GGI emryiission No.-%e4rR=PAft
My COMmisSi0ft E pi rayMY Coff1mW4ko HHo
may 08. 2021 Fvninm iOW12024
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