HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
Building Permit Application
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:
Residential y
PROPOSED IMPROVEMENT LOCATI
Address: (C rc,I ! C rCt LIF
Property Tax ID #: 1 ` 0 -.3't J- - GG j - GG�/-% _ � Lot No.
Site Plan Name: 6uN> C e>1eft C e Block No.
Project Name: 1M/'10'rj CA&43
DETAILED DESCRIPTION OF WORK:
- �8�1 cat e�ce (�Cn:>/.r jC_ CJL,-
-- — - -- -- — - W cAr 5 G (tn
New Electrical Meter Second Electrical Meter �]
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -
echanical V/ Gas Tank VGas Piping
Electric /Plumbing _Sprinklers
Total Sq. Ft of Construction: t(-�- j ,�
Cost of Construction: $ %/GIF C/C/ CiD
OWN ER/LESSEE:
NameZ11�-fl7C-7cW C-�cATje
check all that apply:
Address:,XI %Y GIJ d_ Byte 41r�i��, -34E
City: Y e re 66 ec,, c 17 State: Fe -
Zip Code: 31-'l64, Fax:
Phone No. 77.2-
E-Mail: S ezCq qr?� 17 Q/ �3ati •%1 C
Fill in fee simple Title Holde on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: IJcn 171e) A t
Company:an e ( ✓OM &4C//61
Address:).% r► I n i f
City: r-t 61 Crce Statefe,
.
Zip Code: 3YCfly9 Fax:
Phone No 7%,X- 5-44--XX
E-Mail vl/-'7 F)1febr-/1.SC,44& 0 C f_
State or County License C &C QJ C iG T
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.
DESIGNER/ENGINEER:
Name: 1ol cn t0i
Address 1W 3 oLncl
city: r r} / e r•c c,
Zip: SG Phone
Not Applicable MORTGAGE COMPANY: �t Not Applicable
CITY- Name: �CIA�01Q t /!u
n I k Address: q0 t-inoir
State: City: �� _State:
2X ��-6 — �� Zip: 3 L Y Phone 7-
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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, 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 attornev before commencing work or recording your Notice of Commencement.
oail-2il
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA 4
S I%t 61
STATE OF FLO !
COUNTY OF a ie
COUNTY OF���.(.t
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this25•�day of MOa.. 20tl by
thi�� day of 2 11 by
1
Don�rlf�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally KnowrV OR Produced Ide lk1 N01111111
Pype of lddentification
Type of Identification
Q�?g••` ioN•'Fig i5 ,10
peduc
\\����
'CPZGH 14 SFr° .•
`p
N�\\NIIIIIIIIIII////Y
(Signature of Notary Public- of FI a 18S�oN•'•RS' ��i
'G i
(Signature of Notary Pub ic- Sta }OGG 180980
ti
,H14
Commission No. GIG 90 ?04 (A °��s';
ice'•°tea 90
c `
Commission No) � ' F�D0110006.. vow
* ' *
�[/C.
REVIEWS
FRONT
ZON �;
0�5
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEC�y�'0�g
'••R tLV__%N
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/1111111111\\\
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU