HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V 2-0 2I Permit Number:
LuTC LL
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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
I 2�
Address: 5515 �a°�lyQ Dr. T UY�
Property Tax lD #: ` k2 - 0 0 - �(-Q � - o o (-) - 1 Lot No. U Q
Site Plan Name: F1nh-eLt -Jl ft ? 11co, Block No.
Project Name: EhU" l�l�tVok
DETAILED DESCRIPTION OF WORK:
ineo-tallllna rk 22111•S 0r-Coosac1 erGL r-&A(A u gehel!a-�a
alum ft[65LAV wit UQ ftAP 7(5 Vip e t dtAll_W I F I
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
q—
Total Sq. Ft of Construction: 111(p V Sq. Ft. of First Floor: 11 -1 0 U
Cost of Construction: $ 2 , �rj O Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name .pl
Namelb%I't Si(101f�=c�
Address: 5J(S fade i�r .
Company:p—d 12 I 1-,,'2(VECg lVIL
City: . � l 2rC�Q State:'I-
Address: & 11: �OVU Cp ,
Zip Code: 5 ( Fax:
City:Q;JyState:GA-
Phone No. 50ff 2, E-
Zip Code: S 2- Fax: '!
Mail: relit I q so I
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail CVC {
from the Owner listed above)
State or County License EC�`3QQ CM PS
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: Y, Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: KNot Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
nW1UFR/ rn1UTDArTnD ACCsn111-r...
„„ r,, , „JJP11Ldl1Uh is hereby maae 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 conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please co nsu t with your Homeowners 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 hefnrP rmmi-,Ani-ina,A,^r1, „r _r
- -- - - - 1O,.01011 IS YOU, rvvuce or Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�,^n
COUNTY OF i IV
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 20'i1 by•r�.(' f. _
Name of person making statement.
`
Personally Known .)� OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. _ (Seal)
rgAo ►�% ,. HALEY MATHEWS
?� Notary Public •State of Florida
o►n.�" Commission# HH 45081
My Comm. Expires Sep 21,1024
Bonded through National Notary Assn.
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DATE
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Rev 5/20721