HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll Ar' -(' AkiLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IR•36•Q 1 T Permit Number:
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: (�s L-tk-%Ie . 6 Zox�)G*- ��� fCk lil�Cr Uoe.
PROPOSED IMPROVEMENT LOCATION: ii-- nn
Address: Q5 lb �.r41��{,�t�pbC CauaA' P4• `t'1CZLC ��--
Property Tax ID #: OO (0$ • 0 C)O • 3 Lot No. a�
Site Plan Name: Block No.
Project Name: 1>e S1Jp 9.S
DETAILED DESCRIPTION OF WORK:
Zn: - Ik (S'k-t> 1�tz P- -�o cc-'Po36et ro4Yn ev-k� f
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under thispermit—check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq_ Ft of Construction:
Cost of Construction: $ P SO , Oa
Generator
Sq. Ft. of First Floor:
-Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
NameC, e S' --ao e r S.
Name:
C-s►i ►
Address: gSI.O
Company: Ae-,u
JPr iC%&-* v:wlueAek
City: ri, PoercC FU State:
Zip Code: �R9 51 Fax:
Phone No. $(00 • a •
Address: LyIOCj �?E
4L.�Cz
City: so 1.LAAA
Zip Code:3`k"Lg7
Phone No
State
Fax:
`z)(a (L9
F-Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail M 4u k. • ft
State or aunty License
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Horne 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
improve is to youndn
perty. A Notice of Commencement must be recorded in the public records of St.
Lucie C my nd post the jobw ite before the first inspection. If you intend to obtain financing, consult
with le er o an attt4before cbbmmencina work or recording your Notice of Commencement.
Signature of dwner/ Lessee/Corpf for as[Agent for Owner
STATE OF FLORIDA
COUNTY OF 111(14h cr '% rJ
Sworn to (or affirmed) and subscribed before me of V� Physical Presence or Online Notarization
this_ day of liML.. 2(}�11 by
Name of person making statement.
Personally Known _ OR Produced Identification
Type of Identification Produced ,,��11i11111l11�,,.
(Signatuf Nota ic- State of Florida) = re o..� E2os•..
Commission No. (Seal)
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REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR REVIEW I REVIEEW NS I VEGETATION REVIEW SEATURTEVEWLE I MANGROVE REVIEW