HomeMy WebLinkAboutBuilding Permit Application - Purnell All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
t_%Lio Luce -R
Building 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:
PROPOSED IMPROVEMENT LOCATION:
Address: jq RdU--�b Df—
Property Tax ID#: 31-0'5-- A m . (o C 00•�D Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
c a r cQ e� � 0°)d e
dam an -r
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
—Mechanical _Gas Tank a Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator oof Pitch
Total Sq. Ft of Construction: LU)4 Sq. Ft.of First Floor:
3
Cost of Construction:$ I.�) ; 990. ' Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name It Name:
Address 2�gq 12.� J �� Company: OffimmlC ►Q3��
City:� Oycxc.k, State Address:_ l q(5C, S.
Zip Code: -��i Fax City: �d7 lD�l 6 State:
Phone No.�2(.U210�p8 i Zip Code: c-54C`` z Fax:
E-Mail: ��-� r��l [Crory- Phone No 7Z (02J -OZbA
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
Lflue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
lue of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
Lucre County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wO lender or an attovey before commencing work or recording our Notice of Commencement.
aw�v�0
Signature of Owrol
Lessee/Contractor as Agent for Owner
STATE OF FLORIDA /
COUNTY OF �( �
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 20 day of C 201L by
Name of person making statement.
Personall Known OR Produced a tification
Type of Identificati Produced
(Signature of Not y Public- a of Florida) ox'_ Notary Public state of Florida
( 2�2 -A^ —Pamela Jones
�c my comrmssron GG 985470
Commission No. (Seal) �ta�,d� Expires06115/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 572D721—