HomeMy WebLinkAboutBuilding Permit Application I I '
A11 APPLICABLE INFO.M.UST BE.COMPLETED FOR.APPLICATION:TO BE ACCEPTED
!Date:, o 7•1 *a?/ Permit Number:
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�;uildring P mlit Application'
Planning and Development Services
;'Building and Code Regulation::Division- Corbn Utial Residential
;230 Virc3in a Avertue�Fort Pierce FL 34982
Phone:(772) 4624553 Fax:,(772I.462-1578
PERMIT APPLICATION'FQR: ' f
RcPosEatRovInr WcarON .'
Address: / '74eksd/?
Property Tax ID#':-t Lot no.
Site Plan Name: ellf:. Block.No.
Project Name:
DETAILED DESCRIPTION.OF 11UORK
I4 =
Nlew Electrical Meter Second-Electrical Meter
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ICC}IV TRUCTION,I (FORT ATI'0
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
Total S . Ft of` iistru $ Sq.Ft. of First Floor:.
C
st, f Gonstr coon;$ _. Utilities: Sewer Septic, Building Night:
T
WN 1lESSEE. CONTRACTOR: .y
:.
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N.arne o4Z Z-*- Name: .^R1
Address: Company- fV.._r1r ��II YYeu
City: kM. -Stater Address: 1 fr
Zip Code: / i C�7c' Fax: City: Stafe: '
Phone No 416� ° 4!:: �� _ Zip.Code.- Fax:
'E-Mail: / tJCl ',+2a5`f.2' ./Vi�G' 1�:f`/`.L1fd ? Phone No.
Fill.in fee simple Title Holder on next page{if different E-Mail �Xf�' � e % Re'
from the Owner listed above? State or County License 1r,
If value of construction is 2500 or»ore,a RECORDED Notice of�Commencement is.required
tf value of HAVC is$7,500 or niore,a:RECCIRDED Notice of Comri sncesnent.is required'.
SUPPLEMENTAL.GONSTR,LiCTION LIEN LAWINFORMATIQN m
DESIGNER ENGINEER' "N,ot Applicable MORTGAGE.COMPANY•. _Not Applicable
Name: Name.:
Address: Address: ...
City: . _ ;State:: City: States.
dip: Phone. Zip:. _ Ph one:. _
FEE SIMPLE TITLE HOLDER:: _Not Applicable. BONDING COMPANY: _Not App`lieable.
Name: Name:
Address: Address:
,City... City.
e.
Zip: Phone: Zip: Phone i
R,.
OWNER/CONTRACTOR AFFIOVIT Application is hereby made to obtain a permit to do the work and iinstaliation as indicated.
I certifythat no work or instaliation,has commenced prior to the issuance of a permit:
St._Lucie County makes no representation that is granting,a perrtiit will authorize the permit_holder to build the subject structure
which is in confliccwith any applicable Home Owners Association rules,bylaws or and covenants that-may restrict-or prohibit such
structure, Please consult with your Rome 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 l will,in all respects, peri:orm.ti a 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=re`sidentiai'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 Comrnencement 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
.with lender or an attorne before commencing work or recording our Notice of CommencemeRt.'
Owner/Lessee/Contractor as Agent'for owner, Signature o Gonfract /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY Of M4,<7-14 COUNTY,OF 1:11 -7-//'7
Sworn to(or affirmed)and subscribed.before me of Sworn to(or affirmed)and subscribed before me of
4!Physical,Presence or, Online Notarization 4-"Pbvsical Presence or Online Notarization.
this day of 202F by this d ay of 202kby
WhallW f,0 W el`S Y1117 Ju161R
Name of person making_s atement. Name of person,making statement.
Personally Knowi OR.Produced Identification 4l Personally Known. 0 R Produced identification
Type of identification Type of-Idd6tification
Produced AIF .CV17 25 Z4,(:. ��/`'�P{•�,$? Produces!
(Signatur f Notar'y.Publtc fat ,oft larj{ sir � . aura or Flot.da Signature;o ,�,otary Public "State oSbFtor a +µ Fu F,c r c r cri
•.
Lor i A Wi %y Lo A Ma ray a
Commission No; its urn Gi 25a rya h „n ss a o zaa •sa
{5a4 omm"rssion No. G---C o'? ( (
'2? u:c� t ,
wrycf'",a3'Y_ .ems�a'' °A.p•*.,.1'� vt,±lP"xatr�°+}°Ls*`+.w'�:?`"t'��'�''d�Y�'."'�+^ �
REVIEWS- FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE.
CQU,NTER. REVIEW Rl V4EW REVIEW REVIEW "REVIEW''" REVIEW
DATE.
RECEIVED
DATE
COMPLETED
ev: