HomeMy WebLinkAboutApplication 25All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
gi7 . L' j.(,�-,uL� -,z4
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: bcM611t(oh _
PROPOSED IMPROVEMENT LOCATION:
Address: _ Z 2.3 . Lv r l -C, 2S-
PropertyTaxlD#: (t133 -Sri -pp )ol — 00U_ CQ Lot No. rzc
Site Plan Name: h-y� i2 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter N Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply: Ip
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2JL Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namek-L tQ, JtY"I� c,V-
Name:Gjt y-,e, B V'k+ -
Address: 20 2 3 ta. i (LlI ' bud
City: FO r+ p i C )nrrr., State:
Zip Code: 31ACh14 (D Fax:
Phone No. R-)k� 0I?3Qi
Company: Gl � Cr12 Y-"c hx ( C4YtF rgC�r�r l l
Address: ((S (o } 1a pip , Sy ,
City: State:
Zip Code: 'Cio1=y Fax:
Phone No--AQC1"l
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail (oM_
State or County License�In
n vame or conscruccion is eouu or more, a necunutu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
O-L
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 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 attorney before commencing work or recording your Notice of Commencement.
Signaf or Lessee/Contractor as Agent for Owner
STATE OF yr
FLOj2M ,1 Pe
COUNTY OF (j�p�' .h
Sworr) to (or affirm d) nd subscribed before me of Physical Presence or _ Online Notarization
this r day of , 20_DQ by
Name of person making statement.
Personally Known ✓ O.R Pro eed Identification
Tvoe of Identification Pro uc� ed/
(Signatur fNota lic-St teb"rorida)
EE
TIFFANY RENEE DENTON
:ommissio(Seal)MY COMMISSION# GG 243842
.(oEXPIRES: July 31, 2022
F�$: Bonded Thm Notary Public UnderNdlefs
REVIEWS I COUO TER REVIEW S REVIEWOR I REVI W V REEWON PLANS �
RECEIVED
SEATURTLE MANGROVE
REVIEW REVIEW