HomeMy WebLinkAboutnettlesAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
hate:°Z,_r Z Permit Number:
�., '* tip
�c;w r=STD. Building Permit Application
Planning and DevelopmentServices Residential
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34932
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 0Ce 141J
Property Tax ID #:
Site Plan Name:
Project Name:
FDETAILED DESCRIPTION OF WORK:
C
New Electrical Meter.Second Electrical Meter.
CONSTRUCTION INFORMATION:
f
S-0 i—A)o (—oo0--
(Affidavit required)
Lot No-_
Block No.
Additional work to be performed under this permit --check all that apply:
Mechanical GasTar}k _.(3asPiping
Shutters Windows/Doors Pond
_ Electric Plumbing ,Sprinklers —Generator Roof ��. Pitch
--
Total Sq. Ft of Construction: sq. Ft. of First Floor:
Cost of Construction: $ ��Utilities: — Sewer Septic Building Height:
.OWNER/I;fSSEE:
Name C A
Address: 4 U
City: State:
Zip Code: KqFax:
Phone No-
E-Mail•
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: r`L
Company: t
Address: ,r
City: State:
Zip Code: N �"� — Fax:.'- �� Q
Phone No — 4
E-Mail '
State or County License i
If value of construction is 250D 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.
SUPPL MPNTAL-CO_,NSTK . CTI.0N� LIEN A1N iNFORMAT10.N:
Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Phone;
MORTGAGE COMPANY:
of Applicable
Name:
Address: State:
City:
Zip: __ _ Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: ^„ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby madeta obtain a permitto dothe 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 a yiaws or and covenants that msEy restrsl bor prohibit such
which is in conflict with any applicable Home Owners Assoc+anon rules,
structure. Please consult with your Home owners Associa#[on and review your deed for any respr[ctionQ� �+� the workly
In consideration of the granting of this requested permit, l do hereby agree that I will, in all res eo, p
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
s
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming poois, fences, walls, signs, screen rooms and accessory uses to another non-residential use
result in
WARNING TO OWNER: Your failure to Notice of Commencement must be may
paying the publ c records of St.
improvements to your prop y
Lucie County and posted on the jobsite ben the
wo Ic or reco dinn. NoticeIouroof Commenceme t. consult
with lender or an attorneybefore c• m
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn o (or affirm j a d subscribed ?efore by of
Physical Presence or online Notarization
oaL
this day of
Name of person making statement.
n—.,nel+u Vnnwn V OR Produced identification
Commission No.
, W rc, Notary Public State of Florida
Suzette Ri'c-n
4 My Commission GG 136736
N'} a Expires 12112)2421
REVIEWS FRONT ZONING SUPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
VEGETATION SEATURTLE MANGROVE
REVIEWREVIEW REVIEW