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HomeMy WebLinkAboutApplication for permit filled outAll APPLICABLE INF r�ML1 T BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: � 1/�9_oz% Permit Number: S -i, Lt! cud LL r`� 1KIF)' > L 0 1 E L L -° 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: PROPOSED IMPROVEMENT LOCATION: Address:7C:�G.�►c( 7r:rf F_�, ^C_C L 3y"I-_-Z_ Property Tax ID #:. e) ' C> z-- - s Lot No. � � Site Plan Name: a j U, , 0 r! A f .41 Block No. d!IA Project Name: Cw t 1/( l+ T � �r Ct -7 2-67b Jle 7[ 172 r f DETAILED DESCRIPTION OF WORK. el - New Electric I rfeter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: I Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank —Gas Piping Shutters Electric — Plumbing — Sprinklers _ Generator Total Sq. Ft of Construction: Cost of Construction: $ tl Windows oof Pond Pitch Sq. Ft. of First Floor: y 2-- Utilities: — Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name cr[� Name: r7� Address: SZ6 LleAltdol' RJ Company; ' o 1G +2 City: State: Address Zip Cade'1�,�� Fax: City: G-_ Stater Phone No. 7 - Zip Code: _?Y q r z- Fax: E-Mail:r2 Gr ( c� ._ Phone No 72- � �9 Fill in fee simple Title Holder on next page I if different E-Mail 11irL,-k el,2 G from the Owner listed above] State or County Licensei'2jne(a��T2 1i vn11Ar us 46limi ruciuwn is czuu or more, a KtwKutu Notice or Lommencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAll PnihicTRI CnON UEN LAW IWORMATIOW r1fitC�i►i�d lra�wi....__ —. .. Name: Address: City: state: Zip: Phone FETE SIMPLE TITLE HOLDER: — Not Applicable Name: Address: Ctty: Zip: P€ one: MORTGAGE COMPANY: � Not Applicable Name• Address: City: State: Zip: � Phone: ame-If G NCCllillFiA ti! Not Appffcaf�ie IVarrse: Andress; City: Zip: Phone: ©W'JER/ COfyTlai,A[MR AFFIDVIT: Application is hereby made to obtain a permit to do the I certKV that no work or Installation has commenced prior tome issuance of a perrriif Work and ilesiaillatift as irrdicatecL SlhW Lucie Is Cou ct with an representationplacableRome that is granting apermi# will authorize the permit holder to btul # the p4bject.st ucture structure- Please consult withPyour Home Viers hoc at on andmrev_, b our d s, bylaws or an covenants that may. restrictor Pn)IV ttsttch I'n consideration of the granting of this requested y dead for any restillons which may apply, in accordance vrtth the approves{ Plans, the Florida Euii�stg Codes acid agreet Lu a Caranih+ Amen ain all t$. perform the vre�rk accessorThe y, st building permit applications are exempt frorn undergoing a full ccncusrency review. room additions, ry strtEcEures, 3t1imrrting pools, fences, walls, signs, screen morns and accessory uses to another no"esidentiar use WARAU VG Tit OWNER'. YIPUr failure to Record a Notice of Commencement nmy t uft 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 inted to aiatair; frtancing, con t With lender Oran attorne before commencing work or reartfira� ��►��:f nJ�,+..., ,�x,-.._ _-- - as Agent for Owner STATE OF FLORIDA COUNTY OF S*orn to for affirmed) and: subscribed before me of Phvsical Presen ar Online Notarization lists ---•;.day ofr r . .. 2� by iVame of person ss>akirr statement. Personally limmn L�—OR Produced Identification TYpe of Identification CINDY WE 24 Notary Public -State Commission No. '� )Commission # G[ My Commission May 23, 2C REVIEWS I PRONT ZONING CQUNIElt I REVIEW REVIIEWOR Signa#ure of Corttractap- nee Holder STATE OF FLORIDA COUNTir OF Stu= to (or affirmed) and subscribed before ln¢ of p vslcar Presence ors ._ Onf ne Notarizatlart tFTFs. �� a]I l3 � luame of person makirM staterent. Personally Known %"- Ok produced Identirwation 'type Of ldentificatiOn Produced r..�jr�uw�[s a writ , sq ) CINDY WE Notary Public -State -iiommission # GG '•y o-Fi,ti•' `'Y Commission 'hi+u May 23, 20 PLANS REVIEW VREVIEVIlON � S REVIEWE I MANGROVE E