HomeMy WebLinkAboutBuilding Permit Application Alf APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ✓G R0bA*P1�O Permit Number:
st �90 �17
e `c'P coiDa017e*h
Building Permit Application
Planning and Development Services
Building and Code Regulatioh Division Commercial Residential
2300 Virginia Avenue,Fort P)erce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED,IMPR,OUEM;ENT LOCATION:,
Address: �'3 3-7 four w-.A�J av
Property Tax lD#: /�/o '�tZ "00 i —00 0- F ocemw% Ar-JQr+,% Co-Q0 f Lot No.
Site Plan Name: Block No.
,Project Name: - ' / ;u �' ® 3y' S fo E
DETAILED DESCRIPTION: OF WORK';
' �. .1 , d a1A c c O/�Cr + 11
R" g �- d I G e 11 II c e (9 X U �T�1� " . � s � r, r w� �n
11 move,
r e i,.r cam,r e
)e JYo l OA l%pp4 S iJe Gt Jr /l i CAl Grr✓ cret 10'x 3 S i
V�hi�C iQcfrkiAa QP^ea an -'s'ouf-d, s,'ee C� dr�vtl,.� `file �iCk CdAWtkj 3000 PSG
New:Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Addition4work 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: P6ZZ Sq. Ft. of First Floor:
Cost of Construction:$ 9 S-0G, UO Utilities: —Sewer —Septic Building Height:
G
,OWN;ER/LESSEE: CONTRACTOR:
Name Sl)50,11 r,'14s �V Name:- L oL�t@. Dro.,uuANr
Address: Cm JGC'606 ydc-XX Company: two Lal'nrs (-oAStIvn _lor-
City: Ford- P;)CrrR- State: FL Address: IOR5; I�fenrWS �a
Zip Code: Fax: City: State:
Phone No. 77 Z- `I'7S— 1352- Zip Code: 34CA4 S" fax: 77Z 4' Y p1
E-Mail: S SlO 13 a; G Phone No 11 Z U (o 219
Fill in fee simple Title Holder on next page(if different E-Mail ) Jc�.ACS ConS-'rUj-i
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. �$�S
If value of HAVC is$7,500 or more;a RECORDED Notice of Commencement is required. %�
SUPPLEMENTAL CONSTRUCTfON LI*EN LAW�INFORMATION
.,_°�'� i •'-
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:
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 lengler or an attorM before commencing work or recordingyojjr Notice of Commencement.
Signature of Owner/Les /Contr or as ent for Owner Si ure o Contractor/License Holder
STATE OF FLORIDA f ., STATE OF FLORIDA
COUNTY OF [_U COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sw n to(or affirmed)and subscribed before me of
V/ P ysical Presence or Online Notarization ,7 Physical Presence or Online Notarization
this day of Q P by this day of _, - t l�_ .2 by
Zo�-I Zo21
Name of person making statement. Name of person making atement.
Personally Known��OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of t +�Yl?.ublir� t� la) (Signature of oiia }JbIk0'��I f�SWgda
Commission#GG 934051 �' '=Commission#GG 9340�5,1._
Commission N =�. oP�s sGloyember2�, Commission N Pam; ember24,2Q33 al)
BondedThruTmyFalnlnsurance800.38&7019 y� 9' BondedThru Troy Fain Insurance 8N%AW7019
i
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.