HomeMy WebLinkAboutBUILGING PERMIT APPLICATION page 1A APPUCABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: Permit Number:
- 0 L iL
Building Permit Application
Planning and Development services /
&,Wing and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierre Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: Q t O
PropertyTax lD #: ] 31 \ - 901 _ 611 5 —Q6 0" l Lot No. 2-
�/�
1��� Block No. f
Site Plan Name: _
Project Name: L660
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'TION OF WORK:
VC
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
Total Sq. Ft of Construction:'/ Sq. Ft. of First Floor:
Cost of Construction: $ aZgPO -� Utilities: _Sewer _Septic Building Height:
OWNER%LESSEE:
CONTRACYOR "°
Name AhwcWName:
✓A Vl k
✓Plow l
Address: Cj'1 t' �'
Company: C rn a l
G
City: R—P trcf State [i
Zip Code: 5-Fax: n /A,
Phone No. 9681'961.5-'
E-Mail: kILL
Address:
ah.
City: i
Zip Code: 3'7 #3 Fax:
Phone No Q•
Sta e:_L
PL
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C �
e d j - tOW
State or County License d_436c?_
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.
t T� 1111 . ,i
SU11I:EME ' TAL7C°ONSTRUCTIONL'IEN LAW INFORMATION:.
,
DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
Name:
r/_Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
t/Not Applicable
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.
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 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, 1 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
wAhhiender or an attornev before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Co t1tor as Agent for Owner
STATE OF FLORIDA _
COUNTY OF
Swo to (or afPirmn subscribed before me of _ Physical Presence or Online Notarization
thi day of c'v 20L _ by
Name of person making statement.
Personally Know_ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-
pState of Florida )
Commission N n O 41A � (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ii¢-•:. JAIME ORTIZ
`? • �= Notary Public . State of Florida
• o` Commission X GG 226444
My CImm. Expires Jun 13, 2022
Bonder through National Notary Assn,
SUPERVISREVIEWOR I REVIEW PLANS I VREVIEWON I SEATURTREV EWLE I M EVIEWVE