HomeMy WebLinkAboutPlans and surveyAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- ��-� i- Permit Number:
01Y. ILUC0E
O
p Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
fr
ee- ree_ I om Ml / !-f a/rG G Sl9
Property Tax ID #: 1 `Iy /
Site Plan Name: C"P H.S
Project Name:
a. -GG.J > -
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
hiC,oj Reif den c e- C4,7.)IA. c ), ?uk, /14'.0 taw, I h4; It ' %
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 k Windows/Doors _ Pond
Electric Plumbing q _ Sprinklers
Total Sq. Ft of Construction: / &
_ Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ _L UGci0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name w Ma" e..-4
Name: 04711 17 e,
Company:���+
Address: d 46 Oan );7 O f
Address: •/7Y ala (0/XiC #13?«,.73
City: V e rc, 46Ca.0 A Sta e: fL
Zip Code: ) y '*14 X Fax:
Phone No. 7 74- v'tG// 70
City: r% Acrcr- State: f1-
Zip Code: 34,fC1 Yg Fax:
Phone No 7 74'' CY
E-Mail:.SCV a 4nv na E//4''A-AC
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail IA C �i I �dN>♦`1 .A �'
State or County License C G G G 3 (.090
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: Not Appl
Name: it'f 5�G-r-T-
Address: 1W rr fi- Un ,-
City: r-k Viercc- State:
Zip: 3� q- - Phone ?7dt a-a-6 - 7
e MORTG=-S/L-Itc
MPANY: Not Applicable
Name: &.1 K
Address:.. uG 6c,r(::b-nci
City: eIG State: r_
Zip: ,3 X PhonF 77 1 �7 Fr 7
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated
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 Fovenants 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.
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDA � t � •� STATE OF FLOJRI
COUNTY OF 14C► COUNTY OF 'luC�L
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 MOLL.% 21511 by thii� day of 20&+I by
poo hnxi& .41
Name of person making statement. Name of person making statement.
Personally Known' OR Produced Identification Personally KnownV OR Produced Id
Type of Identification Type of Identification
(Signature of Notary P6bli2 eg of
Commission No� 8O 6pC,
REVIEWS FRONT ZON
COUNTER REVI
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary
'� Public- Sta%a
Commission Noc ry`) o
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PLANS VEGETATION SEA TURTLE MANGROVE
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