HomeMy WebLinkAboutBuilding Permit Application - Sancho FrACAIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
212-1 Permit Number:
�'Sl`�E� Building Permit Application
d Development Services Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: \r 1 W\(A)3\t1 �e�)\UU kx%A-
PROPOSED IMPROVEMENT LOCATION:
Address: � A
Lot No.
Property Tax I#: �Jyl " �J30— Q
Black No.
Site Plan Name:
Project Name:
DETAILED ❑ESCR(PT(ON OF WORK:
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 --L Windows/Doors —Pond
_Electric �Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ a 02.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: NN\Ch( 4 1 1 W Q.\LN
Address: LA'5�) �)c QL�3uU - Company: \+e1 D W
State. FL Address: O Y.
City: � ors �- LuC�£ —
Zip Code: 3L1c1n
Fax: City: State: FL
Phone No. -1`1 L 2-03'gXAU Zip Code: 3yc'1�� Fax:
E-Mail: i ti 1 hC* 60• C 01% Phone No—(—"II�) ':)\G1 -C11�
Fill in fee simple Title Holder on next page(if different E-Mail NG-b Cvn CDm
from the Owner listed above) State or County License C I r l I 1
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.
1■y }� J�'�{,_ {jam �ir 1},i( *` tR{/Jy {��{ F
pP MORTGAGE COMPANY. ___Not Applicab
DESlGNER]ENGINEER: —Not A licab{e le
Name:NIA Name:NrA
Address: - - - Address: _
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name:wA Name:NIA
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 f 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 Count and posted on the jobsite before the first inspection. if y intend to obtain financing, consult
with len or an attorne-v before commencing work or recording r'Notice of Commencement.
906ture of O ssee/Contractor Agent,for Owner Sig a re of tract icense Holder
STATE FLORIDA STATE O I,o1111)�,
COUNTY OF t��� �. COUNTY OF
Sworn (or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of
X(Z
I Presence or Online Notarization �ysi l Prese ce or Online Notarization
this of - , 202V by this.�y of 4n1y 202f by
of��I A...0
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification � Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 1. Produced i✓
(Signature o Notary Public-State FI ida) (Signat re of otary Publlc-State of to ida)
Rebekah Hoy Rebekah Hoy
Commission No. O NOTARYPUBL! Commission No. INOTARyPUBLIC
ESTATE OF FLOR DA STATE OF FLORI
REVIEWS FRONT ZONIN s ' �46f$Z 23pL NfA
ANS VEGETATION SEA TURTLE Mtid
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
2V.