HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Permit Number:
Building Permit Application
Planning and Development Services C00tv
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: ��',)V\eS oulw
Address: PQ fC t> &ije 5 Gar, rG 6'-5-1L-9t5"1
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
e' Project Name: e:7 —' -.5 �' We? '.7 C. e
a , � �o 4 , & X$ot� n't—v -Y �- hq�
New Electrical Meter Second Electrical
JN:
STR CT
Additional work to be performed under this permit- check all that apply:
wl'(Aechanical v-"G' a s Tank v-G'as Piping Shutters vIAMindows/Doors Pond
VElectric V"Pl u m b i n g -6:1-2 Pitch
_�-Sprinklers &,-Generator tfRoof
Total Sq. Ft of Construction: -1592.2� Sq. Ft. of First Floor:
Cost of Construction:$ .1Q99.e.9-4.00 Utilities: Zsewer _Septic Building Height:
CONTRACTORr ,z
Name &-4=e--o
Name: NZ4Z122&-A
Address: &o
Company: I- I- f2 On eef k0f
2 tno f-714
city:
State:
Address: -'?4A04
2 61 Y'
Zip Code: Fax:
City: J51 Fie`rer'e- dq,
State:-451
Phone No. 9es ---300 -
Zip Code: .54f9l/ Fax:
E-Mail:
Phone No 77Z -
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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.
SUPPLENiENTA CONSTRUCTION iE 1 W iNFOR�VI,AT�ON
§'u" A -ty, '-s.� - iZ 'iz W -'} rs Y � [Jx' C • .•aK"
DESIGN E /ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Addresslt'S
Address:
City: � Veva G Stated _
City:
State:
Zip: k,a Phon�77Z•.�69-e-2_%
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:.
Name:
Address: O
Address:
City:tfcCity:
Zip: Phone:
Phone: !?D,S
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 recordirpg your Notice of Commengement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swf�rn to (or affirmed) and subscribed before me of
. Physical Presence or Online Notarization
thi day of � i by a
Name of person making statement.
Personally Known _
Type of Id n ' ation
Produced A .
(Signature u iy
Commissio �?
OR Produced Identification
moo
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SignatV11f Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Swor o (or affirmed) and subscribed before me of
P ysical Presence or -Online No arizatiQn )
this day of PA2 K -2870 by
Name of person making statement.
ff Personally Known
Type of lderlpfv
Produced
Commi
OR Produced Identification
,..,..o RT$eal)
SUPERVISOR I PLANS I VEGETATION SEATURTLE--TMANGROVE
REVIEW REVIEW REVIEW REVIEW I REVIEW