HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 010- ,�-00aPermit Number:
L1 ICCI]i�'
((555�7.,
IF ° 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: E,
Address: 222 1 gmlno t5trf-ur Pbt S f G�a} Lajyl
Property Tax ID #: �
IC1 - 5 I S -(/) G2!q - ()LJ-�(GJ7 - 2 No. `
���Lot
Site Plan Name:I/f I UQ9 PM U P � PA ot5 V. I OT 11 Il%I I P [air Al.Q.lBlock No.
15
ProjectName:
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 —Windows/Doors _Pond
14Electric —Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ a:cm - ob Utilities: Sewer Septic Building Height:
---
Name
Address:-M 5L 012MIr Company: -TM l (k d
p
city: J (fff ,5t-- ute- t kState:j`L Address:_Ql%__� SW ,)MX JCl� nr -
Zip Code: 3/4 C� 5 A Fax: City: ',�j-LlQL4ZX State:
Phone No 5 70- a (901 - Oa� l D ,c
Zip Code: 3uOIC)� Fax:
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E-Mail:.�1nj I • C'Li71 Phone Note-) a— � 10J D I W
Fill in fee simpWTitli Holder on next page (if different E-Mail I(Yl Y GiU 1�X C dt7 1'h e 1CPe/ 1`S %
from the Owner listed above) State or County License EC j 3 00 8 U3 lb
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.
'EMENTALiCONSTRUCTI N LIEN LAW INORMA
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: ,Not Applicable
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 lender or an attornev before commencing work or recording vour Notice of Commencement.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF i Vl()IJR�i l ii
Sworn to (or affirmed) and subscribed before me of --- 1,/Physical Presence or _ Online Notarization
this lapday of Tu— v — 20ZL by
IM0LAtV1- ,w _P G lt-2-S o n
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced DYIVf IS I 1 j_` p n s-P .
Public- State
Commission No, IA ( (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
T000 M JONES
• N ' NOlaly 7L51:. State o' Florid,
�'.a''�•� : COmmisslor = GG 359413
My Comm. Expires Jul 26. 2023
aoraec "Imsh 1lationa: Notary Assn.
SUPERVISOR REVIEW REVIEW I VEGETATION REVIEWS REVIEW LE I MANGROVE
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