HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPL CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
C ate:
Permit Number:
' - Building Permit Application
Pr.nning and Development Services
Bidding and Code Regulation Division Commercial Residential
2'W0 Vi -ginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: r�
PROPOSED IMPROVEMENT LOCATION:
Ad::ress: 430)-a nw �.1�ry,Ct y \ ;-!
1
Pro Derty Tax I D#: L414 Q(n- S3o - Oc)\O - GCUC/ - D Lot No.
Site Plan Name:
Pro ect Name:
DETAILED DESCRIPTION OF WORK:
Nei+ Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Acditioral work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cos . of Construction: $ 21 2 u o • UCH
OWNER/LESSEE:
Block No.
(Affidavit required)
Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Nc m e �. % L1 ei.- c i � ❑ s Guru 5 , _1- q � I u t-N
A: dres,: 2 -4 y S , ✓-e �r�,r� .� i�r ��
C ty: � _)Ca.4.eState: iVl:V-'
Zia Code: L� 3 Fax: �-
P -io n e W o.
E-Mail:
FiL in fee simple Title Holder on next page ( if different
from tre Owner listed above)
CONTRACTOR:
Building Height:
Name: ) �- „y__r S 1 err. ,art
Company: j'-,r-c+- `i U c. �- v- , "c L (-
Address: I L S
City: 3c n �,, c) State: FL -
Zip Code: 3 `1ci S -_J Fairer t- 7-v �--
pf�e� I-ti 4s Q o -- 603 S '33 3
E-Mail �_a b c,-vu- l „n.
State or County License f) -C: - 3 C.' r5 i I
If value o- construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value o- HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
S.JPPILEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGIIER/ENGINEER: _ Not Applicable
Name
Address:
Cary:
2 in:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name _
Address:
City:
Zio:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
OVWNEF/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cei tify t iat 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
whi:h is.l-i conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
strxture 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 a-cordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
Thefollowing 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
W,.RNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
imp,-ovements 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
witr lender or an attorney before commencing work or recording our Notice of Commencement.
atu a of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF u r + In
Sworn t:3 (or affirmed) and subscribed before me of c- _ Physical Presence or Online Notarization
thefS'"dayof D-j l:4 20al by
Name o- person making statement.
Pysonaily Known L-- OR Produced Identification I
T•»e of dentification Produced. 0 r- ; r_A r_.' De t �.A v- s L - Un"
�(a cr'
(> gnatere of Notary Public- State of Florida )
KAREN
Cxnmission Nor_=G LIV I bb I MY COMMISSI ON#GG #G
(Seal) *:*tv.
ISO981001
Q� EXPIRES: Apol 23, 2024
`';Q Bonded Thru Notary Public Underwriters
1EVIEWS FRONT
COUNTER
DV,TE
RECEIVED
D. TE
C�:,MPLETED
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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