HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L �cLuC,uL�
r J �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential o�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 6100 PJIV406o 7ri Ve -fora- P'44-a- -F:6- 3' X:;'L
Property Tax I it: 310 Z-- 160 2 — 0 ( to q _ 0C) C) — 2 � Lot No.
A1
Site Plan Name: a05+1 � /Alo/n .5 �/%rQ/L`lsT Block No. 5
Project Name: N. t _J�f
DETAILED DESCRIPTION OF WORK:
v
New Electrical Meter Second Electrical Meter a��
(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 a Roof 5112 Pitch
Total Sq. Ft of Construction:
32.00
Sq.
Ft. of First Floor: _
Cost of Construction: $ 3/,
203 . /6
Utilities:
_ Sewer _ Septic
Building Height: /D r
OWNER/LESSEE:
CONTRACTOR:
Name I . P,I? r
Name:
Address:5100 PlAI- GG �Y
Company:
City:-T (- -Vt 6rce, State:
Zip Code: 3 `f qff� Fax:
Phone No. 20 E-
Address: 3/H2 5S' Q jjit ES t
City: JiUQY State: �G
Zip Code: Fax:
Phone No}�� 83— fS03D
Mail::D�u/yf�f��ia�kXoL/�s /!!i
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License CCG133,;L316
it vame or conscrucction is zouu or more, a KtCOKutu 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:
ucatatvcnl ctvulimccn: _ ivoi Hppucaoie MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
wvvnson/ bwix t nmt i un /irrnJvi 1 : Application Is hereby made 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. I
St. Lucie County makes no representation that is ranting a permit will authorize the permit holder to build the subject structure
which conflicts with an v applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult 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 an sted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender o attornev hefnrp rnmmpnrina wnrk nr rnrnrriinex vnnr At..+;,e f r,.,..__
Si re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF r !7'n
-94,2
6
Sworn to (or affirmed) and subscribed before me of _
Physical Presence or Online Notarization
this _ day of . 20_ by
_
�vlce R lara
Name of person making statement.
Personally Known OR Produced Identification
Type o I ntiflcati
1
(Signature of Notary P blic- a of rida)
Commission No. (Seal)
'iisv;;"d'•; THERESAJAFFE
Notary public -State of Florida
q•3�'I Commission N GG 202301
.,orM1 f My Comm. Expires Apr 1, 2022
•!-Bonded through National Notary Assn.
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