HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE 1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� / Permit Number:
U e i, c L' C - 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: 40 0/1000(
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PROPOSED IMPROVEMENT LOCATION:
Address17
vo N' / aeo! f' i Z` 5e;l� %—11 G(�'`1 !"� 2���
Property Tax ID#: S J2 — 70I — 66 :7.1 060 — y Lot No.
Site Plan Name: ( y Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I cu Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: f CONTRACTOR:
Name 0,il Name: tul N 1
Address:^^ d ) C� Company: / e if ri" %v g ' l�
City: . l} von State:04 Address: — i W
Zip Code: _ Fax: City: Cc State:
Phone No. N/0 S p7 —3 Zip Code: Fax: `77�7-��J—�U�1�y
E-Mail: Phone No 1—
Fill in fee simple Title Holder on next page( if different E-Mail (,f�� 1) a/ Itco)' l
from the Owner listed above) State or County License 14 — 5
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is S7,500 or more,a RECORDED Notice of Commencement k required.
11E R; Not A PP�i able MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: �v_ Address: ,�( _
City: Stacie:' —�'
Zip: Phone �� State:
Zip:. Phone:
j FEE SIMPLE TITLE HOLDER_: _Not Aprdir-able 80NDING.COMPANY: Not Applicable
fName: _ l Name:
Address �_ Address. --
City: --
Zip: Phone: Zip phone:
OWNER/CONTRACTOR AFFlfDV T;A60dWon is hereby made to obtain a WFMit to do the work and installation as indicated.
1-certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation than is grzntirrg a perm authorize the.will au the permit holder to build the subject structure
which is in conflict YAith arty applicable:Herne Owners Assaciat�c>n rules,by#aws or.ancovenants that may restrict or prohibit such
structure.Please consult with your Home owners Association and review,your d,ed for any restrictions which may apply.
In consideration of the granting of this requested pernrA,l do hereby agree that I wil.1,"rrt all respects,perform the work
in accordance with the approved plans,the FWida$uiidirig Grades and St.Lucie County Amendments.
The following baflding permit applications are it+retreft from undergoing a full concu7..pa y review.room additions,
accessory structures.SWII tiF;g pools,fenwu;V atls,sins,screen rooms anti accessory uses to another non-residential use
"WARNOW TO OWNEW YOUR FARt#.U�.TO A MdTXX OF MAY RESUILT I N YOUR PAYING
T FOR �lF'— T. Y PROPMW. A.NI OF C.0 VANICB1111111311T MUST 13E RECORDED AND
POI ON THE !OB SLI1E 8001RE Tl!# lFMST RAPKTWK JIF YOU RVT'EIX TO OBTAIN# FINIANC31111111I CONSULT
`"TM 1rO W LENM OR AN Anwmy soon nEconmilix Yam Nana OF ."
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Signature of Owner/LeSs-ee(srorrtractoras.Ili 14h for Qwner Signature of ContractorAlcense Bolder
STATE OF FLORIDA STATE OF FLORIDA C —
COUNTY OF
COUNTY ,
The forgoing instruln)§ t was acknowledged efo"me The forgoi ig instrum was ackrwviiedged before me
this/m ay of t �0.21 try this 'id'ay ot fLfIt 20 by
Name of person rnakhit statement. Name of person making statement.
Personally Known CAR Produced Identification Personally Known OR.Produced Identification
Type of Identification Type of tdentificaron ---
Produced Produced
j
I
(Signatul of Mary P96 ic-Late of F '
rSigriatesre Pubric-State of Florid
COMM j Commission Sea!)
EOWAP11117,20:
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REVIEWS RVISOR PLANS
LA GROVE
COUNTED REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW —I
iDATE
RECEIVED
DATE
COMPLETED
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