HomeMy WebLinkAboutBuilding AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� , 61. Q 1 Permit Number:
51 r. L U,C�L1L 4711
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X. >C.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: CT 7(i J 5tm� hry, I)r ram,
Property Tax ID #: a ?skn - J C> a UG'a5 — LGDo -• o Lot No.
Site Plan Name: �►Y�Q 7_ rZ S L� (.) b Block No. P14 T•
Project Name: h��c�t� ��ii nt �r`�l t3t. Pt-1A-aF— I %�
DETAILED DESCRIPTION OF WORK:
�.
New Electrical Meter YG Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_."Mechanical _ Gas Tank _ Gas Piping i-Shutters ` Windows/Doors _ Pond
rElectric _/Plumbing _Sprinklers _Generator i''Roof 64/ J� Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 1 3d)
Cost of Construction: $ / �J� UoL _ Utilities: ✓ Sewer _Septic Building Height: J- r !
OWNER/LESSEE:
CONTRACTOR:
Name Hie,hae-A -+Belt
Name: 41514
Address:_ 143,0 �G rY110 Cad. aN
Company: k6AJ qF-1 % Ul tJf,,r'S L-Z-'C•
City: VYiP,a &M I State: ALY
Address: Z)e9zt-1 81 -o 677E ley
"City: 2 ,Y-f State: f2Q
Zip Code: Fax:.
Phone No. qL7 _ rIA4I L 4e74
Zip Code:�4- I?q q Fax: 717o2, &q.2--
j
,
Phone No 1/ 70, 61!2a.
E-Mail: 1'b6Lll o_I-y L ►/e rj �sn nLA-t-
Fill in fee simple Title Holder on next page ( if different
E-Mail t-Ae -, ey ,nmy.e G f'Q�1pf hgmy-S,
State or County License 683 , /a4
from the Owner listed above)
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.
k"
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
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:
OWN ER/ 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF j-F Lucie,
COUNTY OF si- ,Lade ,
Sworn to (or affirmed) and subscribed before me of
'-10 Ph sical Presence or Online Notarization
this J day of• , 202k by
Sworn to (or affirmed) and subscribed before me of
�Ph sical Presence or Online Notarization
this day ofJL )kA . 202� by
Name rson making statement.
14Y2, ee_ICL_
Name o%ers making aking statement.
Personally Known ✓ OR Produced Identification
Personally Known v OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signa e f Notary Public- State of Florida)
(Signature o Notary Public- State of Florida )
Commission No _ osS.ROWgSeA)
?0,OkY din
* Commission#HH122364
Commission No. RHOwAS.ROWE (Seal)
�pY PUB<
ro`,•••••,'O Commission#HH122364
025
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SUPERVISOR
PLAN S
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A TURTLE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.S 2