HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number:
Ll
Building PerMit A pplication
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone : ( 772 ) 462-IS53 Faxt (772 ) 462- 1578
PERMIT APPLICATION FOR :
PROPOSED IMPROVEMENT LOCATION:
Address: � v � ' e l `—t
- , a '.• . C. > M
Property Tax I D #: J .�'� - (D p n ^ �� � ,� - o 0 0 Lot No.
Site Plan Name: Block No..
Project Name:
1 . r
D I ED DESCRIPTION OF WORK:
/P.0
lip
( )P) n .00
hp— C, EMEP LA
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 T Po nd
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq . Ft of Construction ,., � � � Sq. Ft, of First Floor: - - -1
Cost of Construction: S � Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: - - CONTRALTOR:
Name Name : j vro-vz;6, aMOM
Address: � � awl Company: 1�v ,G � S e 0 V10 (5e s
City: �o�n..- � .z ✓ L. U State: Z! Address: t
Zip Code: Fax: ( city: C S ��cv�,� Q statE:
Phone No ,, 2 a Z � Zip Code : ''� 9 � 3 Fax: t
E- Mail : 14 '1? e, ).0 �Z _, � �^ . cry"'" Phone No. 21 a Sg ko
Fill In fee simple Title Holder on next page ( if dfflerent E-Mail O � %-M., CX
from the Owner listed above) State or County License � G G ! S�2 9 3 Z o
If value of construction Is 25W or more, a RECORDED Natke of Commencement Is uIred.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRU ION LIEN LAW INFORMATION :
DESIGNER/ ENGINEER: Not Applicably MORTGAGE COMPANY, Not Applicable
Name : Name :
Address :,,,,,. Address :
City: State. � City: St at e :
Zip : Phone l ip; Phone :
4
FEE SIMPLE TITLE HOLDER; � Not Applicable BONDING COMPANY: Not Applicable
Name : Name:
Address :_ Address:
City : C i ty.
dip : Phone : Zip: Phone :,,,,.
OW N E R/ CO NTRACTO R A F F I DVIT: Appl i cati on i s h ere by made to obtai n a pe rmit to do the work a nd i nstal l ati on as in d icated.
I ce rtify th at n o wo rk a r i nsta l latio n h as comm e nced pri or to the issua nce of a permit.
St. Lucie Co makes no representation that is granting a permit will authorise the permit holder to build the subject structure
which Associations in conflict with any applicable Home Owners rues, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wrth 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 wilt, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie bounty Amendments.
The following building permit applications are exempt from undergoing a full toncurrency review. room additions,
accessory structures, swimming pools. fences, walls, signs. Screen rooms and accessory uses to another non-residential use
WAR N I N G TO OWN E R&. You r fa il u re to Reco rd a Notice of Com mence me nt may resu lt in payi ng twice fo r
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and pasted an the jobsite before the first inspection . If you intend to obtain financing, consult
with lender or an attorne before commencinp, work or recordinp, your Notice of Commencement,,
Cob
Si nature of OwneF/ Lessee/Contr'actor as Agent for Owner nature of Contra ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA •
COUNTY OF COUNTY OF Ilk
Sw rn to (or affirmed) and subscribed before me of Swart to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarizat4P
ion
P'
th i 10 day of 1A d2 R i 3Mby this day of C�1� �. i �, . ?�'�y
r
1A -
nJh'. r&IM--wo
kin kz ) Z I
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification � Personally Known DR Produced Identification
Type of Ide c n Type of Identi
Produced 7Produced "Y � � � LTAW
41
(Signature of Notary lyublic- State-of Florida J � nature of N ry Public-5tate
�YP W`.'. commissio _ . , AUof<Ey B. HUPPIAREY�� EYB, HUMP
commissio W. �' � : SON � GG
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�'• �a EXPIRES: March fi, 2023 :�.'• ��: EXPIRES: 9mch 6, N23
- -
REVIEWS -Rim
J old
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FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/Lu