HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J- Z r ZU z I
Permit Number:
C 3)J.N -V
C C:l
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTaxlD#:y��Z--(�L)f �(5a�91F�C�r�r, 7
Lot No. Z 3 4 Z q
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New. Electrical Meter Y Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION:
Block No. Z_�Z_ c/
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank — Gas Piping Shutters_Windows/Doors _Pond
IElectric _ Plumbing _ Sprinklers _ Generator Roof
Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ I repo , n Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name r1 ,nna. i'r,d�r
Address:_ �()y
City: ,. C1 r it State: L
Zip Code: �LIoCScz Fax:
Phone No. ? 7 -z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: tui'lliaw, (>ll s
Company:Cv /,-, -/ r ' , ci
Address: 12L,17 s ) Ke_l_ s r-V CJOr
City: for4 Sc .-,4 LLxc,'r State: F-L
Zip Code: _� y q cX 7 Fax:
Phone No_`7? Z. 3-7n (or ci ;�--
E-Mail V M_
State or County License f-1 13&( 2. 7�
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 INFORMATInN-
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City..
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: . Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: __ Phone:
— Not Applicable
State:
Not Applicable
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 cornmenced 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.
_ �ItLucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
hender ®ranattorne before commencin worl< or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as A ent for Owner
STATE OF FLORIDA
COUNTY OF_ S A . C
Sworn to (or affirmed)
) tand subscribed before me of
this 2Z'10 da of Physical Presence or Online Notarization
y ,Al4 20 z t by --
Name of person making statement.
Personally Known ) OR Produced Identification
Type of Identification Prpd.ucecl,
re of_,Notqrj Public
Commission No,
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
I IVI IUCI 1
OWN CO S
MISSION Q516
EXPIRES: JAN 01, 2024
80nded through 1st State Insurance
FRONT ZONING SUPERVISOR
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COUNTER REVIEW REVIEW
PLANS REVIEW VEGETATION I SEA REV EWLE I MANGROVE