HomeMy WebLinkAboutBuilding Permit Application Ail APPLICABLE IN 0:MUST BE COMPLET Olt APPLICATION TO BE ACCEPTED
Date: q Permit-Number:
ON ��tt ������ ''ffR RECEIVED
ro rL SEP 14 M71
B[t;<10lding Permit APPIkation St.Lucie County
Permittin
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300Virginia Avenue,Fort Pierce FL 34982
Phone:.(772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROFOSEQ IfUIPROUEME6�fT LOCATIC}N f x F
�66 r- � . 1
Address. I=t7.V�
- �t-T �C� aw`5
Property Tax ID#:. : 214 Z_e. - 14 k ` ®OO Z r 7 ` Lot No.
Site Plan Name: 4 Block No.
Project Naive: 1 I ��-=fNn4s 1C�-p-1'1 C...ci
DETAILED ®EcRIPT)ON CIF 1lIL
ORK°° r
s
New Electrical Meter Second Fiectrica eter (Affidavit required) Y42 �5��.
AdditionaIwo rk to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric umbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction:_ �_ Sq. Ft.of First Floor:
Cost of Construction:$ Clo 0 ,G Utilities: —Sewer —Septic Building Height:
OWNERJLESSEE _ CORITRACTOR �
t �I
Name 1 -`�� -tip Name: \,
Address:
-- .J J _a\ 'A\J1Jc y-&S R Company:
City: 'Vt e,rC—e— Stater Address:
Zip Code: �)qo B k Fax: City: State:
Phone No. -1-7 Z - 7 0 S %_2-)5C45 E Zip Code: Fax:
Maii: i_ o bt nCic�s�-���ur�� -ni I Phone N
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 HAV£is ViS013 or more,a.RECORDED Notice of Commencement is required.
SL#i'PLEi1llENTAL C®NSTRUGTtON L(EI LAW iNEC3RUlA iQi~i y'
DESIGNERJENGIMEER: Not Applicab{e MORTGAGE COMPANY: Not Applicabley
Name: Name:
Address: Address:
City: State: City: State,
Zip; Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: of Applicable BONDING COMPANY: of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone-
OWNER/CONTRACTOR AEFIDVIT: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 conflicts with au applicable:Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consullt 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 before commencing work or recording our Notice of Commencement.
Signat of Owner/Le ee/Contractor as Agent for Owner
STATE.OF FLORID
COUNTY OF CL.JCC—_i
Sworn to(or affirmed)and subscribed before me of 'k Physical Presence or Online Notarization
this day o r 2r by
` l
Name of person makings atement.
Personally Known OR Produced Identification
Type f identification roduced .
(Signature of Notary Pu State of Florida)
KLLIE H0F�NWN
Commission No: �'��`"
O (Seal) =o_-,°��: Notary Public-State of :orca
9d�o Commission=Hi 382 8.3
µy Comm.Expires jar. 4:2025
Bonded through National Notary Assr..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED,
DATE
COMPLETED
Rev 2