HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -7I 1' I Permit Number:
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>; t2 "w" Building pp 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: C0nsfrC4&h s— of S; �c,�e darn I I t e-( r
PROPOSED IMPROVEMENT LOCATION:
Address: Ncl S • � .
//II l�
Property Tax ID #: 3SIT
�" 3 2— - ��D —/7 — i 0 ' �lan-L '�. � Su
Site Plan Name: �IeE1F 4_
Project Name: l.lC��'l� 42g2�--! denCe RUn,�e— L4) C(6
New Electrical Meter �< Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
i _Mechanical _ Gas Tank _ Gas Piping
Electric XPlumbing _ Sprinklers
Lt
Total Sq. Ft of Construction: _T n 1)
Cost of Construction: $ 5� Ot
Shutters
Generator
X Windows/Doors _ Pond
X_ Roof Z Pitch
';� 001
Utilities: —Sewer ;Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Se0-1"`t_ n I
Name: IZ G_n U ' 5
Address: 1 1D 0O 5 L r; Cam"
City: PC rf ST. State: FL
Zip Code: -2> Lf C1 -.) Fax:
Phone No. -1 S 03 ZS
Company: Hz I L L
Address: ���� G A t 61v J -7ooL
City: f State:
Zip Code: 3 3 "{ I (D Fax:
Phone No 5% i— &D 3— ULf
E-Mail �D•
E-Mail: Sc- � I
Fill in fee simple Title Holder on next page ( if different
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN/ENGINEER: _ Not Applicable
Name: ) )) I Gt() -. a)e-2--
MORTGAGE COMPANY: � Not Applicable
Name:
Address: lk,a -p
City: State: ILL_
Zip: ?6 y z(r, Phone S b I
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: V/ 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 vour Notice of Commencement.
, :D,
Signat re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF PC- t i-r\ &:-i
Sworhto (or affirmed and subscribed before me of Physical Presence or Online Notarization
this IT day of 2091 by
Cl (1 �Q V I S `\��11 LYNIN p���/yl�i
Name of person making statement. -I- �-I �z po�s�� • 'y
Personally Known D--, OR Produced Identification
T pe of Identificatio Produced z 12n3
OLc--e � a
(Signature of Notary Public- State of Florida )
Commission No. I414 1249 3 `f (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING SUPERVISOR I PLANS I VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW