HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date: �1,2,7- 2.J
.,A4rED FOR APPLICATION TO BE ACCEPTED
Permit Number: al0qnv ' U0'�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 ,
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
.PROPOSED IMPROVEMENT LOCATION:
Address: 1f 00 111 LO-6 jE (JA' J
Property Tax I D #: ✓z �' lJ - D 0l °7- Db 0 -i Lot No.
Site Plan Name: UPDD V110-MC O Block No.
Project Name: '5CDTT f LJ 5 A-) I- SYntD 22L31
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L DETAILED DESCRIPTION OF WORK:`
RC -Move CX 15 Tl kl o FLA—i eDOF d N R E- RftME uV i M Z x 1 D
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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq.' Ft of Construction: _520 ° Sq. Ft. of First Floor:
Cost of Construction: $ 2, o 00 �y Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
Name WA NAU, • �.010 kLL-
Address: hU [lI NT7M, - It kt/
City: N 6Lsi L� Statek-
Zip Code: Fax:
Phone N( 772-) W7-300
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name.
Company:S
Address: �D(Q(��inl'7f-�IF�' !-✓✓a<�
City: Potr5ruj 01.8r State:_r
Zip Code: Fax:
Phone No 0 OV-D 2-(PO -Y1 Id t✓N6 r� 8 FuSdt.,—N• Pci'
State or County License C C7C152 -1 a
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.
0
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 attorneybefore commencing,work or recordingour Notice of Commencement.
SUPPLEMENTAL CONSTRUCTION�LI.EN LAW INFORIVIATIO:N
DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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Sign ure of Own /Lessee/Contractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA �l
COUNTY OF �
COUNTY OF A o :
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Sworn to (or af