HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAElf IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Permit Number:
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I; c ' , E E, t- �_-- Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential t
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: GKK&FNC9 A C Clir�K6c nuT _ ( =a FbQ Lr
PROPOSED IMPROVEMENT LOCATION:
Address: �I U .)_ YAk/A YA L) V, . �F� /
Property Tax ID#: Nog-(IO-�583'000- LotNo. _5
Site Plan Name: /+ pIB� Block No. 87
Project Name: COLC CSZDENCC
DETAILED DESCRIPTION OF WORK:
EitiERGeMCy AR NA0JGr_- OUT -
T�sTauTNrT � 35-roN; l�1 sEFR
SYSTCM Ws-T-14 A I6kw 4eATER
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
xMechanical —Gas Tank _ Gas Piping — Shutters
Electric _Plumbing —Sprinklers —Generator
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Total Sq. Ft of Construction:*
S ! Q
Cost of Construction: $ (015
Sq. Ft. of First Floor:
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—Windows/Doors — Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LAwREMCC
COLE
Name: MARK A.
S E
Address: GI a EAFAVA NZ.
Company: QZTTL
SMC
City: FT. Pzcvce State: rL
Zip Code: Fax:
Phone No. o/ c{- elnoq E-
e�ss: o2
Addr'f
',
LzFAf L
City: WEST l
Zip Code: q 15
Phone NoC5G-1 y3�'alg7
bEACOState:IF �
Fax:
Mail:
.CAM
Fill in fee simple Title Ho der on next page (if different
from the Owner listed above)
E-Mail Pt'rvl It-S�gzt11
QC. COm
State or County License
CRCoyq a 6 3
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:
UtbIGNER/ENGINEER: y Not Applicable
Name: 7�
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: 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.
St. Lucie County makes no re resentation that is ranting a permit will authorize the permit holder to build the subject structure
which conflicts with only 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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recordin¢ vour Notice of Commencement_
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA!!-� ''I
COUNTY OF f'Ali'l AC N
Sworn�°�y �or affir ed and subscribed before me of 4k ➢hysical Presence or _ Online Notarization
9�►[9R ((��
this _cNay of . 2(�?] by
MAU, A. Vz►,,jE.s
Name of person making statement.
Personally Own 7d OR Pr duced Identification
Type of I ificaY n Produce
ure of Notary Publi - tate of FI '
(Zmmission
• y�'r •t�, Notary Puohc State of Florida
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