HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1,411-4PPLICABL UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: go Permit Number:
—Permittingn
.91r. Luc M
-o
-==°- -- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
P'ROP®SED IMPROwEMENT LOCATION,:
Residential X
Address: 5SL OS �lZI"In 6 P1ttc- Ft 7r"e/c2,, FL 3:y4�1
PropertyTax lD #: 13 /1 — 76) Q 00-1 coo _L/ Lot No. S3
Site Plan Name: Block No. 3
Project Nam�yli,��
New. -Electrical Meter- - _ -- ..Second Electrical Meter.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping "45hutters
(Affidavit required)
Windows/Doors _ Pond
_ Electric _ Plumbing, _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: --c Y& • 7
Cost of Construction: $ y ._
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSE'E T
C®.NTRACTOR•
�,
Name If_ m i%y 19 Xtye-
Name: �JP FF- lea
Address: 9205- &E.,nin i9 PL
Company: GP vinS�y► 6ur'f If
City: Ft Pre « State: FL
Address: _/ e 3 7 &.M n A R CL
Zip Code: 3 '� �� Fax:
City: !�%S f Palm. 154 � State: �
Phone No. SLj ,,? SS " 911 L( 2
Zip Code: 3 3 yD 9 Fax:
E-Mail: 2r1'!i�/ Q/��fes gh'!Cir/. Co.H
Phone No ,SZv V 7/ 2' et Z
-Fill in fee simple Title Holder on next page ( if different
E-Mail De /Zmr'fs (9 -1ew h Sdrl �u I i.f•.
from the Owner listed above)
State or County License G li l5/a. y Z.3
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.
SUPPLEM�yENTALPrCONSTRUCTION LIEN LAW INF!�ORMATION ' $�
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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:
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 recording your Notice of Commencement.
Signature o O ne ssee ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF l r? [c.�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
)&&
this _ LU day of J f— , 209� by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary P lic- State of Florida )
;ot�iiv'vuB4 EKATERINASTROGANOVA
Commission No. (Seal) ? • �= Notary Public - State of Florida
Commission # GG 272948
My Comm. Expires Oct 31, 2022
Bonded through National Notary Assn.
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