HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: c_ 1(09 , 0M
girl ILUCUIE
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Residential
PROPOSED I,MPROVEMENT.iLOCATION
2�� ��Cl62ia)� ���� �te��� � Address: lc,�?`J�-
Property Tax ID #: 3qc) 2- - %6 Y~ 033C C 00?- 3 Lot No.
Site Plan Name: kt1 i C rJ D K-r--o - Block No.
Project Name: TcS tI _ Da_,,j e V e- - R_yJ
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 V/ Roof Pitch
Total Sq. Ft of Construction: I &V f J !q Sq. Ft. of First Floor:
1p
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE
._
CONTRACTOR:'„
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Name oe- oli l C✓i�� Ql eo
Name: mi4xa--1 2.:;,6rfe,S
kc.,
Address: 15, ZC)� � - � ii.'�
Company: 7_A. iY0Sk_
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City: pLe-f-c-t- State: r/_
Address: .`i i o-rmAve-
Zip Code: Fax:
City: J/ co 6-e-ItC-H
State. `-
Phone No.
Zip Code: `Z a
Phone No - S-Z
Fax:
m 6 0
E-Mail: keri` Y 00 t
Fill in fee simple Title Holder on next page (if different
E-Mail
c7.1ai
from the Owner listed above)
State or County License '
& l , 3 re
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 INFORMATION
'74,
DESIGNER/ENGIN ER: _ Not Applicable
Name: A
MORTGAGE CO ANY: _ Not Applicable
Name: A
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
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 vour Notice of Commencement.
re of
Owner
STATE OF FLORIDA
COUNTYOF ,
Sworn to (or affirm d) and subscribed before me of ��Physical Presence or Online Notarization
this &gday of ��, 20�-J-J by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
�oL�Z
(Sigphtdre of Notary Public- Stathsof Florida)
L6$HAHMINQW4FJ
MY COMMISSION 0 6Commission
No. (Seal)
-s
EXPIRES:pecemW20,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
MANGROVE
REVIEW