HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (Q- L3 -7;-A R11:0/ED Permit.Number:
JUL 31011
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Building Permit Application
Planning and Development Services,
Building and Code Regulation Division Commercial Residential /\
2300 Virginia Avenue, Fort Pierce FL 34982 L
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Shin ke _�o Ma°J0.� iP - r40��
Address: %! D q 'ice i(-&mar u e F L 34I95 1 _
- DOO —d Lot No.
Property Tax ID #: )'30 03 -n D
\DoG
Site Plan Name: I.a_ke woo �csC 1� Block No. 1
Project Name:
HIM
rc o
duPr a,-k A C_t Ur\`e1r _ �
New Electrical Meter Second Electrical Meter
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
T . Ft of Construction: Sq. Ft.,Of First Floor: pro 8
Cost of Construction: $ I �c�j , �00 Utilities: _Sewer Septic Building Height:
Name e l ory 1•
Address:? O.y, i'�iir'0.Mat- . r uy
Ap
Co.mpany Z:i ._ owS oo i (� L
y l D
F <{
Git 1 State:1:
Ad'dress `I Sea f 3 i1
Zip'Code y S 1 Fax:
'Crty:' �� ��°a•C%� State: L
Phone No. ? - % l - 8� (0'3
Zip Code: 3D-9 f!oFax:
E-Mail:
Phone No 77-%q3-(9yS
Fill in fee simple Title Holder on next page ( if different
E-Mail Ziechlojzsk i 06 i f1 ^,k l C
State or County License r
from the Owner listed above)
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.
DESIGNER/ENGINEER: _ 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 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 jobsi before the first inspection. If you intend to obtain financing, consult
with lendepgr an a or ey before'c mVAing work or recording our Notice of -Commencement.
Signature of Owner/ Lessee Contractor as Agent for/Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
'3:t1d,10►C1
COUNTY OF
COUNTY OF
Swo to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
this day of 202d by
Ph icaI Presence or Online Notarization
this day of —YLL %-a Zpa1,�6i0 by
2 �a� ACK
�.r-C �C)Losk
Name of person making statement.
Name of pers n aking sta ent.
Personally Known OR Produced Identification
Personally Known Y_.OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Notary
(Signature of otar ublic- State of Florida®r'sw
� �� nature of Notary Public- State
�� �o��,,, CHARLENE
R
Commission No. .. State of
(SeComm#H
Florida ff ``
' ion No. -C� a1rj��yS
�F'� 4ti Notary Public-Sta
=. �) Commission 0 1,11
e
Expires
/30/2024
= �,�o�A.` My Commission
� oil Jut 29, 2
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