HomeMy WebLinkAboutBUILDING PERMIT APPLICATION L
1
All APPLICABLE INFO MUST BE COMPO;APPLICATION TO BE ACCEPTED
Date: 2 �����n e�It Permit Number:
10u�t�
O f .
Building PermitApplication
Planning and Development Services /
Building and Code Regulation Division COMrTlercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772-)46271553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
��.:°aL x.'s33''- „ ,*.:.--ssR-.[; —.,yt -^, ; ,.t-,:T�'-- .•*-TM,;;;+ �s a i h .�•. ,'k�3• ,7� i'- ,',r.-'. 'is tea„ �3 -w i' �`' xr v '•
�.. , �ry ��$`' a`1 S''.'.3'µ� aaa"j�
.6. .> ,.H.__. >.a..,..,.....a. .,b>.�,. ..� __._uµ. ...... r_..?...,..n,....,.....,. ,: _.. ..a!-E.' .x '" ,::"?t,' s�. .?..'�.. ;,.'. •>� =t�....;..�'a''��' ' ,r.+::.�,�,. .s,. �,' ,.v_
..
Address: Zb s be-4-h u rj ��. . l�t;e�-c�, �L 3 q g 571
Property Tax ID#: l3 02-057 000L? Lot No.
Site Plan Name: Block No.
Project Name:
° = •"h .,v' axe,. x 2
DETI=LED QSGIIPTIUCFXIVQRL
[ -,,, r�. '`.=..'.tM k1� �'r,`e. »,-.:ez'?-a
_
E 4 i hI-1A A „ct..2
New Electrical Meter Second Electrical Meter (Affidavit required)
'g'•7 ,� t.. a r* ... ' '-t. . ".. ,eta
colsTcTlc �; R -ro rd f
- v t
w ,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors Pond
_Electric _Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ S, 010 Utilities: _Sewer _Septic Building Height:
��e�IYEI�' L�s� ''� I , -s�rT .w�}"` s#�: a�3.��'-c � � �„. �>•$Y.�'� F � �� r .� �'c�{'" � r '��': �' =_a= 'g . ,�`�^t °�
Address: A r-'h uys• .12J• `Company: JP 6e✓Ic3rQl r�vL �ofrn�
City: • �f P/>`e State: ^Address:
Zip Code:_5w)571 Fax: City: 1 emcp- State:
:i
Phone No._'772- �Scl- �?gl 1 Zip Code: SL44z-15 Fax:
E-Mail: Phone No ���27 2►t'o_ t C�1g
Fill in fee simple Title Holder on next page(if different E-Mail p P✓-�p 1Z�1/i as�0001 C®�2
from the Owner listed above) State or County 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.
I '
1�_INGI
DESIGNNEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip:- Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 Build.ing 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 len or an a;tqrney before commencing work or recording our Notice of Commencement.
Sign re ess a f O r/ /Contractor as Agent for Owner
STAT FLORID A - ,
COU OF ,
Swor to(or affir e n subscribed be re me of Physical Presence or Online Notarization
this L day of�- .201AI by
M (A im n P&I�i P� , ,
l Name of"PEUon makin statement.
i
5
Personally Known OR Produced Identification
ype of Identification Produced
A �kk . 4-
F {Signature of Notary Public-State f Florida)
BROOKE LAPLANT
Commission Now-JO5 I I fl, (Seal) r°• �� Notary Public•State of Florida
EMy
Commission#GG 951670
�'?of Comm,Expires Feb 24,2024
ed through National Notary Assn.
r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION' SEA TURTLE MANGROVE
COUNTER' REVIEW 'REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
1. RECEIVED
i
DATE
COMPLETED
ev 20/21