HomeMy WebLinkAboutBuilding Permit Appliction - hunt pe skAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % I a la.l Permit Number:
` 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: aaai Swk1p rU Gib
Property Tax ID #: 145 Colo-7 Lot No. LI 7
Site Plan Name: HoNr Block No.
Project Name: Ir-1 U&rr
DETAILED DESCRIPTION OF WORK:
Rr'-MoU9 YS 57r IZOOt= '19RSTEM Dr wry Ta QlZrCTN
New Electrical Meter
kr 111UOVIL 1t:LJUij1=uf
f CONSTRUCTION INFORMATION:
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 X Roof 5 1:k Pitch
Total Sq. Ft of Construction: 985 3 Sq. Ft. of First Floor: agj 3
Cost of Construction: $ t:10(a O Utilities: _ Sewer _ Septic Building Height: 20 F't_
OWNERAESSEE:
CONTRACTOR:
Name- "3-®E RU RT'
Name: 'LUGS Qt 3XQ QJQ
Company:�}�IVO
Address: 8 S !S $av"3&5 Ay w
Address: Vs2Q7 ,�q�Q T"z C%iR
City: ?OQ-r 6A111\JS L U CZ-5 State: fL
Zip Code: _3(-jcl 52 Fax:
Phone No. 4 `- 37C� �a1�
City: i=Olr%- Rcro -e State: FL
Zip Code: 14q(4$ Fax:
Phone No -772 - LI(-(6 - 1134
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail -TNir'p 4j P4r>F5 dy t2l-liW<3wM
State or County License CG.L 13 31 t4-72
—_- _ _ _-..- _ .. _. , , ,,. ...., # a ,wuw Ui wImnencemeni is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
TALC, ,
t, s
DESIGNERf ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: ____State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
BONDING COMPANY: of 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 jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA p
COUNTY OF l_
�A i I �C i
Swor or affirmed d subscribed be me of Physical Presence or Online Notarization
tay of 20 I by
his Z
Name of person making statement.
Personally Known OR Produced identification
Type of Identification Produced
Qivare'5f
Notary Public- State of Florida
o.R..► KATHERINEHAVENS
Commission No. (Se MY COMMISSiON 4 Goi65030
EXPIRES: DEC 04, 2021
Bonded through 1st Stats.insurance
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DATE
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COMPLETED
Rev 5/20/21