HomeMy WebLinkAboutBuilding Permit ApplicationAlf APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: uu Q j Permit Number:
o ILunc_Ei
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a e
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, fort Pierce FL 34932
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 1M?oCk WjrldOuJ p1aC4xv,ex��
PROPOSED IMPROVEMENT LOCATION:
Address: 1031
Property Tax lD#: I Lk Z - QOk - 000 LotNo.�__._
Site Plan Name: Block No. T5
Project Name: _..
DETAILED DESCRIPTION OF WORK:
1Yn5'ra.11' 2 i f air
%% ., r_r.
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
—Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric — Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ __%,) I ()QJ] . 00
Generator
X Windows/Doors
Sq. Ft. of First Floor:
Roof
Utilities: _ Sewer — Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
NameQ NA
Name: i,
Address: kC)UCJ pinC
Company:
City: f-byt' pt State: FL
Zip Code: 34q4V-) — Fax;
Phone No.
Address: `i
City: foy k 1 State: mil.
Zip Code: 34gff _ Fax:
Phone No QLO
E-Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
.r
E-Mail (d ir►) Co CA
State or County License- C& [r5l1 q l
....0 — — iyI6 Mi LIVII a &jVV LP n}VICI d I[C%.VKUr1J NOTICe OT Lommen cement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: MORTGAGE COMPANY:
Address: Name:
City: Address:
State: City.
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable BONDING COMPANY:
Address:
Name:
City:
Address:
Zip: Phone:
City:
Zip: - Phone:
Not Applicable
State:
—Not Applicable
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-r d
W
es emlal ARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for use
Improveme to your property. A Notice of Commencement must b recorded in the public records of St.
Lucie Cou and posted on the jobsite before the first inspection. ou intend to obtain fins ing, consult
with Ien r or an atto�rnef before commencin work or recordi our Notice of Comme ent.
Sign
Zure of Own / e/Co cto Agent for Owner
S ATE O O j
CO U--------------
(f
Swoto (or affirmed) and subscribed before me of
I/ P ysical Prgwnce or Online Nat rization
this day of` Zflby
Name of person making tatement.
Personally Known OR Produced Identification
Type of Identification
Produ ed
(Sig4unf Notary Public- State of Florida j
Commi ionjlo; •.,
—� /G7�RDEN }
Notary Public-- f
• . 7 e4, = S,aiL of Florida
Commi
y Comm. Expir s Doc 18, 2021
REV] oughNaior�iQN SUPERVISOR
DATE CO REVIEW
RECEIVED
COMPLETED
re of
tTAW0fFLORIDA
�� `�
COUNTY OF
S t to (or affirmed) and subscribed before me of
P ysical Presence or Online Na�t rization
this day of4YW�7
20Atf by
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8�
Name of person making statement.
Personally Known °' OR Produced Identification
Type of Identification
Pro e
t'
(Slgnat c- t of "I i
,:'t;:i;r i�','"'•. BELINDA GARDEN
Commi i0 �yS:F Nolar Public—sl teoMorida(S al)
+�\) Commission # GG 169025
My Comm. Expires Dec 1fi, 2021
,$nntlsd Ihfouy National NolaryAssn,
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