HomeMy WebLinkAboutBuilding Permit- UPdated All APPLICA IL,E,INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: �i o4 - oM
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`, ' `' 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
PERMIT APPLICATION FOR: N eo Su_N rnmm " ocl _ Ce_s4e_ �21
PROPOSED IMPROVEMENT LOCATION: 0
Address: 6LOL-7 c 4eAE 1 I LJ I'� 3 1 i 4
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: W16MOLcot+CA
DETAILED DESCRIPTION OF WORK:
14' x2aYA Pool Dk'Mens�'0-�,S, LoA 12aye -J46< - 05182-EL -
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: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: 4 CONTRACTOR:
Name Ursa- Name:
Address: -7q OxAp Company:
City: PDA_Pt'eyu_ State:) L Address:
Zip Code: 3qCo Fax: City: State:
Phone No.(-71.1) 3-70- 371, Zip Code: _ Fax:
E-Mail: MlSSU 1Oale amyl -e-yo Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
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: Not Applicable
Name: r.:,-SA Crt Knee-k-t 41-1�' Name:
Address: iMTSIe er Address:
City:& m State: r i- City: State:
Zip: 3A1,13 Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not 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.
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, 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 job-site before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/L ssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF —t;4 L LJCA-)e_
��J
Sworn to(or affirmed)and subscribed before me of ` Physical Presence or Online Notarization
this / day of 5!W 20_Z-]by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary P ic-State of Florida )
Commission No. (Seal) HEATHER BURFORD
State of Florida-Notary Public
�= Commission # GG 183217
;foF�oa,; My Commission Expires
Februar 116, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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