HomeMy WebLinkAboutBuilding Permit Application 1
AII,APPbCQBLE INFO MUST`BE COMPLETED.FOR,APPUCATION TO BE ACCEPTED
Date: Permit Number /
Building Permit Application
Planning and'DevelopmenfServices , l
Y
Building and Code Reguladgn:Division tornmercia I Residential _.... . .
2300 Wrg* -Avenue,Fort Pierce FL 34982
Ph"orie::(772):4624553 Fax (772)4.62.4578
PERMIT,APPLICATION:FOR;: 'RIC
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Address. q. _ ,
PropertyTax ID°# 40 Lot:,No:ap���'
T � .
. .Site,Plan Name;. US1 �� L 0• � _ Block No.
Project Name: IS �Qr.CI.Q'.
-
TAiLa RI: CRI 'TIQN WwOli 9 M � X ` v
s4':A .., « .
PVC,
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New-Electrical'Meter Second:Electrical-Meter
CQITIfC '# 111tlFOfi�%I1?rT(Oi! '
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Additional workto be performed under this pe..rftit—check'all'that apply:
`Mechanical Gas'Tank _Gas Piping _Shutters _Windows/Doors Pond
Electric _Plumbing _'Sprinklers _Generator _Roof Pitch
Total So.Ft of Construction:; Sq. Ft.of First Floor
Cost-of Construction:$'S p r i. Utilities: Sewer _Septic Building Height:,
;nWNERJLSE� s r CONTRCTOR x
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Name. Q - Q - Name. IL
Address:` q A, Company ad1( C
l City: CrAl Vicr cc State$�L, Ad, ess
1Zip C3400a Fax: city:,:Pb C State.-II..
Phone No(`�VAZ Zip.Code. Fax:
E-Mail: r_.i : ':1 .� ,Phone"No _
Fill in fee simpie Title Holder onnwit page(if different E=Mali ,. •.
from the Owriertisted above) State or County License _1 4 9 5
If:value.of construction is 2580 or more,a RECORDED Notice of Commencement h required:
If.value,of'RAVC.is,$7iSo0 or more;.a RECORDED Notiee.of Commencement is required.
F
DESIGNER/ENGINEER: _Not Applicable MOR%AGE.COMPANY ;Not'Apphcab e.
Name: ._ Narrie:
Address: Address:
City "State!, City State
Zip Phone Zip:, Phone:
SEE SIMPLE'TTLE,HOLDER;; ,Not Applicable BONDING,.COMPANY:; _Not;Appficabfe;
Name: Name:
Address: Address:.
City,: Ciity
- ,
Zi,p: Phone: _ Zip: ._ _. Phone: .
OWNER/CONTRACTOR AFFIDVIT'Applicationis hereby made'to obtain a-permit_to do:the'work'antl installation as indicated.
I certify that noVork or installation,has coinmen'ced prior to the issuance.of a permit.
St,Lucie County makes no representatton that is'granti4a perm►twilt authorize the permit hblder-to build the subject structure:
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants:that may restrict or prohibitsmh.
structure:Please:consult:with your Home:Owners.association and'review your.,deed for any restrictions which may,apply.
Inconsiderat on"ofth:e,granting of this-requested,permlt,Ldo'h"erebyagree that a will,ih.all respects,perform-the-work
in'accordance'with the_'approyed'plans;the Florida Building Codes and St,Lucie CoLnty Amendmer ts:
The following building perm itappi.ications are exemptfrom undergoing-!full coned cy review:room;additions;.
accessory structu"res,swirnMing pools,fences,walls,signs;.screen rodms and.eceessory uses to an6ther non=residential:use'
WARNING TO OWNER Your failure,to Record a :m Notice of CwWwheneementay resuit in.paying twice for
improvements to,your property A Notice of.Commencement hi st: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.attorne before commencing woe;or recording our,Notice;oftommencerhent
Si natu,re.of Owner Lessee Contracto g /, Agent for-Owner Signature of'Cgntraetor/License Holdef
STATE OF FLORIDA STATE OF FLO IQA
COUNTY.OF a Lucx.c COUNTYOF� Gt`C,. ..
Sw�iri to(or affirmed);and subscribed before me,of Sw/kin to(or affirmed}and:subscnbed before'ML-of
y Physical Presence or Online NotarizationP�jysical:Presence'or Online Notarization5.
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this 202J by this dayof , &1 2624 by
h � . VYn
Name of p.,rson making statemer�t,����1! Ihl��j� Name ofpe;�on.inaking statement.
.GOMi� xp����jtitnez2
Personally Known: O��c ; ��, Personally Known- �ONation
Type of Identification ` ° o?to y ���� MissToN"`�'
g N Q 7q r } Type of Identification .Q ao3.oe-t ��
Produced R Y �s - Produce 9�
AV
PU
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BZIc
{Signature of Notary Public= (Sldnat6m bfNotery Pub : . of Flon `'
OfiFLOR\�P� � ,9 #GG98� - P��•�.
Commission No. Commission:No. rFQF
.. _.
i REVIEWS: FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW, REVIEW REVIEW,
DATE
RECEIVED:
DATE
COMPLETED
ev:5/6/20