HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COM D FOR APPLICATION TO BE ACCEPTED
Date: 3 - 6 -Z/ Permit Number:
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1. 1 0 � Building Permit Application
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Planning and Development Services StL`C1e county ent
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:
Subd;v� '�On � ��- urlea� C,rrr.S
Property Tax ID#: sn/ C963ge c900 'e/ Wj)2 oC-Lv 'S Sand 8 And C Lot No. C04-7
�s�F-►- o F i.a�-s G��-7 3
Site Plan Name: Block No.
Project Name: _-
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
L/ Electric _Plumbing _Sprinklers 4Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR: <
Name QMaGeT.Zarc r ZS4A&AI 4., Name:
Address:"3 S cS: A&Lk -7'4 1U. Company: �S .F/ec7/�i`� a'�s% �e&.-;
City: Tyr /,e f et Stater Address:/AP& L7 QL�4r�
Zip Code:3y9 V-C- Fax: City: t=--7--- e/e,-- State:
Phone No. 77.2-57D -/BJV Zip Code::: f! FZ Fax:
E-Mail: Phone No 77a 546s 236 9
Fill in fee simple Title Holder on next page(if different E-Mail toe5®ctS�l.Cowl
from the Owner listed above) State or County License S4C/3ao7•2-63
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.
_ _ I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: k Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _C Not Applicable BONDING COMPANY: ZL 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 lend r an attorney before commencing work or recording our Notice of Commencement.
Sig O er/Less a/Con ractor as Agent for Owner
STAT OF FLORIDA
CO NTY OF s�,LCG G iC
Sworn to(or affirm d)and subscribed before me of Physical Presence or Online Notarization
thisday of_ *4.*4_f7— 2WZ by
17
Name of person making statement.
Personally Known ` OR Produced Identification
Type of Identification Produced
(Signature of tart'Public-State of Florida )
Commission Noe^rC 36'-Z 3,.� (Seal) sr•r Notary public Swe of Florida
Randolph MCDaniel
r • My Commission GG 352355
Via ' Expires 09/07MO23
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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