HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %W '0AA- Permit Number:
: �zj�
9JI,
pi , Building pp 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: Ne"'J �Tvfv ,— 'baVrs
PROPOSED IMPROVEMENT LOCATION: f rn41 f,'.rAr'-k
Address:
Property Tax ID #:
Site Plan Name: Jim v. l
Project Name: G Q`�
DETAILED DESCRIPTION OF WORK:
eV^0JV N " & `ri 1 0,xv,n N o � Nt WJ
-.inn P AjLr�a A 00'r f ^V �-'J ►`N i r
V1
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_ -5fi?5--Ift a f a s2c
N a m e: 0' ► .JIN
Address:_ 1 1hv',r.VX\A Vj6,��
Company: a 60yy os >Ks�.,o�r L.4.4.
City:. orb. 5I • _1�•�c t� State: R#.
Address: all-o IV �l�r►% I-,V 4
Zip Code: 4 G1 Fax:
City: _'4-J ` * Stater
phone No. i ,." - $7
Zip Code: 9 011 to Fax:
E-Mail:_;nnat%%,^njIV -e-31,114`] g! 26121 Ct]M
Phone No I!J - 9135-
Fill in fee simple Title Holder on next page (if different
E-Mail to.%
from the Owner listed above)
State or County Licensees 13 ? IQ
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:
Applicable
Name:
Name:
,XNot
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
4Not 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.
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.
SigfAture of OwskrJTessee/Colrtrarroras Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor to or affirmed) and subscribed before me of /physical Presence or Online Notarization
�( )
this l0 day of 20Al by
Name of person making statement.
/ ``,��111i�f��i�I
Personally Known OR Prod u ed Id ntific Lion V ,�•� P %64010 (,t$ rr,�
Type of Identification Produced�����iS �'Q y` '��.•�OjAR�'•,��Xdw
.
My C Expires
. COMM ; .!.
- o __.. Mf7
(Signature of Notary Public- State of Florida )
Commission No. 66 afl (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
e�
septemw— -.
.• No. GG 75g757 Q'
C, • '.X e.rrP,U..B+ +OF�.0
••`
,�'ProtOF •�
SUPERVISOR
I REVIEW VEGETATION EV EWI S REVIEW MANGROVE