HomeMy WebLinkAboutKline PAAll APPLICAJ3LEI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater I Ln ��L Permit Number:
Co iJI
Building Permit Application
1
Residential
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: ; _ �" `f l'`'
Address: �� n�7 ( &A Ofosrs I (` Cour-�
Property Tax ID#:
Site Plan Name:
Project Name:
DETAILED
ORK:
Lot No. i
Block No. ('g
r- X)r-,L Uy 1 k� Loc'
cfc mr 1 SiIA cg c ILtsls� r1 or
pcE "I P'c, i y Shv+4'r r5
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 YWindows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _
Total Sq. Ft of Construction:
Cost of Construction: $ 1-7 " 2-
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
-
Name 0-wl (, t [ !
Name: 1 n !2c_5
Address: %(OCI gPC C(ossb! L
Company: en
vz
City:w( of LUtoe� State:
Zip Code: 'i(A, s2 Fax:
Phone No.cl Y4 5 3 `I G0-)
Address: LJ L>_, O( L,
City: �`'-ygoo 6tl (t
Zip Code: 3`I Z io Fax:
Phone No Ct Spa `/1�1cm
Stater
I
E-Mail:0L-t y 'r r-,fCf)2T C,( CZ.a-1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ' ��L ttd ix>>
State or County License
If value of 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable � MORTGAGE COMPANY:
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
Name:_
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
_ Not Applicable
State:
Not Applicable
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, 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, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
_7)
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO,RIpZ NCI COUNTY OF '
S°rn to (or affirmed) and subscribed before me of
T``. Physical Pre ence or Online Notarization
this (LQ— day of CCC K 2029 by
ff Zv-y 1
�CW L (t 6 l l r1,0_
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced 4k rL�,
LCam- -cj
(Signature of Notary Public- State of Florida )
Commission (Seal)
Signature of Contrac or/License Holder
STATE OF FL I A
COUNTY OF ►��
S\�of.n to (or affirmed) and subscribed before me of
Y Physical Pres e or Online Notarization
this l b day of ,:fl' by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Prod
(Signature of Notary Public- State of Florida )
Commission No�- tgZoS! (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/10
J' Nvar = .Saec =_r a
�,�►�" • Notary Public State:72
!� Shara r. ; IN,Shana L Curtis
t� mac.^..mss:ar. GC s4z�3' My Commission Gcxe es Z222�2?er n Expires 12/22/202