HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
`Lo L a C H Le- 7!!
Building Permit Application
Planning and Development Services �[
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: ChorkCS Sc hIn C4f fi I206tj -TUr'il er
PROPOSED IMPROVEMENT LOCATION: 10150 5r,11 Ave- ' i .pcicrikmcf rt 3 Lictlw;?
Address: 106C &CA Nt f7j , pt f PC e , � L 3i1q '% a
Property Tax ID #: p� Liar "l U k • 4(3 13 • C) 0 0 Lot No.
Site Plan Name: Block No.
Project Name: s Amid � t TUB atr
DETAILED DESCRIPTION OF WORK: Jn Q
CU1 d
0� (� lL= -
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION�INFO�RMAT�IONW:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors — Pond
Electric _ Plumbing _ Sprinklers X Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I a �QLAW •i1 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name(.'Vur\es SLhP_fttAV 1ztYo►n Tvfrwr Name: J LCY, PhIN'la -
Address: 1°150 �C�� AVe • Company: A (- , ena�r �'1 w
City: F r� Qlflf[�' State: FG Address: °13LI 3U C1 SVV
Zip Code: 3�19`6� Fax: City: V 2r' u Stack State:-r—L
Phone No. -11 Q ' LIU S ' 3SU'6 Zip Code: 3 °l U Fax:
A Phone No'11'4 ' (111 ' a 01 2
E-Mail:
Fill in fee simple Title Holder on next page ( if different E-Mail KuceP, e 0,CCV(C4t9 i!e— and fC(,�If16I0A1i•
from the Owner listed above) State or County License 4✓ ► 30c� "l't3 "1
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.
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do tree worK ana insiauavon as mU1LdLeu.
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 of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 1n&Q-Y\ ' 6VV
Sworn to (or affirmed) and subscribed before me of % Physical Presence or Online Notarization
this a day of 3 Sk 120 at by
4eS �C.�(1fh1 Gi
Name of person making statement.
Personally Known OR Produced Identification 7`
Type of Identification Produced DT iVIWI
ILCM�1.4
(Signature of Notary Public- State of Florida )
l� 0i OUt� `b13 (Seal)
0f R1ai '
Commission No. ) ScinrlNchnann�im MH 041d7S~031MIN
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW