HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential k
2300 Virginia Avenue,Fort Pierce FL 34982
Phone! (772) 462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: SV !Y) fQ(
PROPOSED IMPROVEMENT LOCATION: `
Address: .� � C QA'G E/"' Sf.
Property Tax ID#: a Lillaq — 6O 9 Lot No. 1'7 AAd 18
Site Plan Name:_ Block No. 41
Project Name:
DETAILED DESCRIPTION OF WORK:
lGar od'E exi.1 Irmo coo f and i"sial( n. w L, me.+g/
anA oncl� l ymen.�
New Electrical Meter Second Electrical Meter
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 sl/1 Pitch
Total Sq. Ft of Construction: 02i5" Sq. Ft. of First Floor:
Cost of Construction: $ 7SG Utilities: — Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name W 1 6' fI P. A? LeC Name: I rt' alone
Address: Fi I nd� A*Lle Company: T d c�
City: nor', 021 State:l- Address: / 9 /6 St.!
Zip Code: 310 S l Fax: City: )2(r4 SA ZV4•e Stater
Phone No. Zip Code: 3d494V Fax:
E-Mail: Phone No 77d -37o 9770
Fill in fee simple Title Holder on next page(if different E-Mail Jeep ink C AAOa.� -
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.
DESIGNER ENGINEER: _Not Applicable I 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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney befftmlliw
work or recordingour Notice of Co
7 rd
Signature o n L ee/Contractor Signature of Cont t License Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LUCOUNTY OF Sze CuCG
Sworn to(or affirmed)and subscribed Sworn to(or affirmed)and subscribed f
. L Physical Presence or OnlinPhysical Presence or Orlin N i n
this A da of IQa,�J� this 4 day of4&-"Y4pName of person making statement. Name of person making statement SIPersonally Known � OR Produce Personally Known X OR Produce I tia
i Type of Identification Type of Identification R
Produced Produced 1�
, J
Vw—
(Signature of Notary
/Public-State of orida) (Signature of Notaryy Public-State o lorida )
Commission No, V 17 a/y1�'y (Seal) Commission No. VGa7V'�Sa (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.