HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —e c Permit Number:
S1LLB cL
L L c L' tti Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential J�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: _ ftWn
PROPOSED IMPROVEMENT LOCATION:
Address: `TWO A-, X&T 3U ► D 17A jq—
Property Tax ID #: ` s—o'� Lot No._
Site Plan Name: JVhq- Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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: (�,�,�(,,CJ
Cost of Construction: $ �,, T'). G'
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name a
Name:Ayr:e�/)
Address: 00 Ir
I U2
Compa`ll �
pilvi r
City: �QI1Sp'1 �cCh State:
Zip Code: Fax:
Phone No. `�
Addres��
\vie e t2l�u
City: Q State: �r
Zip Code: 3� Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
19 ovw/'
State or ounty License
_
40—29J-36-141
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.
II
Name:_
Address:
City: State:
Zip: Phone
, , FEE SIMPLE TITLE HOLDER: Not Applicable
game:
,Xddress:
! City:
zip: Phone:
MORTGAGE C MPANY: Not Applicable
Name:
Address.
City: State:
Zip Phone:
BONDING COMPANY:
Name:_
Address'
Zip:
_Not Applicable
Phone: - -- -
OWNER/ CONTRACTOR AFC: APO&Won is hereby made to obtain a permit to do the work and installation as indicated.
1-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 thepe rmit holder to build the subject structure
which is in conflictyvith antr applicable Herne Owners Association rules, bylaws grand covenants that may restrict or prohibit such
structure. Please consult wrth your Home owners Association and review your deed gec any restrictions which may apply.
,onsideration 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 a{spiications areexentpt from undergoing a full concurrency review: roam additions,
accessory structures, swiflr► wng posts, fe► , wyalfs, signs, screen rooms and accessory uses to another non-residentiai use
"w^RjMG To owpmx Youn IFANd1RIE.To ra I A NOTA:B OF MAY RESULT III YOUR PAYING
T"ICE FOR Q I �11 S TO YOUR Psapillffff. A NOTICE OF MUST BE RECORDED AND
POSTED ON THE JOS SHTE B THEE FIRST SPEC7101lI. W YOU VMW TO OUFAI1I FOUMCIYG, CoNsuLT
m Y(rtllt:LEWO OR AN A77MM E84M RECORDMIC YGM N07KE OF "
Signature of Owner/ Lessee/C tractora's
STATE OF FLORIDA
CaLINTY OF- . 4aCIe.
ThebQrgq�ng instrumt was acknowle more me
this ! day of j l�(/�.,Q, 20 / by
LIM U) tSoV1
Name of person making statement. ng
Personally Known ✓ OR Produced tdentifitabon
Type of identification
Produced
Ao_�
tsignatu-r# of NotaryPMc- State of }
cornmissia
b
Gundmift*00
Signature of Contractor/License Holder
STATE OF FLORIDA j aC ---
COUNTY OF 7tt
The f �8 instrum was acknowledged fore me
this Ylay of 20 -) by
L� k: i M cy-1
Name of person making statement.
Personally Known �_ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of I
Commission t. AP[v.NiW EY
REVIEWS PLANS _RV15flR PLAyS GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DECEIDATE
VED
SATE