HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAII APPTICABLE INFO MUST BE COMPTETED FOR APPLICATION TO BE ACCEPTEDDate:Permit Number:Building Permit ApplicationPlonning qnd Development SeNicesBuilding qnd Code Regulotion Division23OO Virginio Avenue, Fott Pierce FL i4982Phone: 17721 462-L553 Fax: l77Zl 462-!578Com mercialResidential K.-----r--..--PERMIT APPLICATION FOR:PROPOSED IM PROVEMENT LOCATION :aao'".', t tl).,, o Tc ri ga-r' R4 6.F Crcnr e , Fl .3\q\( .eroperty rax ro+; 23a I - io I , Dull - Dno-r-l Lot r,ro. ISite Plan Name: Block No. RProject Name:d Po.-rNew Electrical MeterSecond Electrical Meter(Affidavit required)CONSTRUCTION INFORMATION:Additional work to be performed under this permit - check all that apply:_Mechanical - Gas Tank _ Gas Piping_ ShuttersGenerator_ Windows/DoorsRoof_ PondPitch_ Electric_ Plumbing_ SprinklersTotal Sq. Ft of Construction:Sq.Utilities:Ft. of First Floor:cost ofconstruction: S 3\ 'l92.aj_Sewer _ SepticBuilding Height:lf value of construction is 2500 o, more, a RECORDED Notice ol Commencement is required.lfvalue of HAVC is $7,500 or more, a RECoRDED Notice of Commencement is required.DETAILED DESCRIPTION OF WORK:[4,^,\rl c. ,x' X 5'1' Poo\ s crean E nclo.s trre,OWNER/LESSEE:CONTRACTOR:Address: JName SIp v p ". Ko?aczip code: B\qqS Fax:Phone No.E-Mail:Fill ln fee simple fitle Holder on next page ( if differentfrom the Owner listed abovelStAtE: ELZip Code: -!f!$-1- Fax:E-Mail A\\' o\ \otQ6e\\S6ul$^. rie-+State or County License Cbc \2-S 1n3.QCity:Company:City:G-} P', -..Phone No
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:DESIGNER/ENGINEER: _NotApplicableName:clalq E Gund€GonAddfeSS:41fi raoismi rraa unitlolState: FLZip: rrsszPhOng ea1-3sf5eoo_MORTGAGE COMPANY: x Not AFplicableName:Address:City:State:Zip: _ Phone:FEE SIMPIE TITLE HOLDER: x Not ApplicableName:AddressCity:zip:Phone:BONDING COMPANY: x Not ApplicableName:Address:City:Zip: _ Phone:OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installatlon as indicated.I certify that no work or installation has commenced prior to the issuance of a permit.St. Lucie Countv makes no reDresentation that is erantins a oermit will authorize the oermit holder to build the subiect structurewhich is in conflict with anv aoolicable Home Owiers As5ociation rules, bvlaws or and covenants that mav restrict 6r Drohibit suchstructure. Please consult wltti iour Home Owners Association and reviiw'your deed for any restrictions Which may adply.In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the workin 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 additiontaccessory structures, swimming poolq fencet wallt signs, screen rooms and a€cessory uses to another non-residential useWARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice forimprovements to yoqr property. A Notice of Commencement must be recorded in the public records of St.Lucie County and p/S.ed on the jobsite before the first inspection. lf you 'Frend to obtain financing, consultrororb commencins work orr Mo{ice of Commencement.STATE OF FTORIDAUI I, ^ A TCOUNTYOF .\ffiW.<)Sworn to (or affirmed) and subscribed before me ofPhvsical Presence or Online Notarizationtr&aav ot :Lt-.,r-'(--- , zozofoyName of person making statement.sworn to (or affirmed) and subscribed before me ofOnline NotarizationSTATE OF FTORIDA W I./ I rI 1Phvsical Presenci6i{dayot r.-Name of person making statement.;ffi-. rotz,,ilrollr stattof t orc:Mytonrm. ElPn€s SeP 29, 2021: BmdedthrolqhNatiffdiictervAsr;1cH ttLE cAvlr-NoraryPublr tateolrlori:'"ioi*ri''on " cc tts"*i,lyComn t'P rossEP r! r\