HomeMy WebLinkAboutCamp Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
p ' j Permit Number:
pate: O I
n Building Permit Application
Planning and Development Services Residential
Building and Code Regulation Division commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: C
3 3 N o+ n' 1� I I=p r .� t C e L
Address: T
Lot No.
Property Tax ID #: �J �J (�e� ` GCS
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
V i 1 1►-v10- sS
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1 ZC30 . ()Q
OWNER/LESSEE:
Gas Piping
Sprinklers
Shutters
(Affidavit required)
Windows/Doors Pond
Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
CONTRACTOR:
Name Q n c GL
Address: ? 33 NOA-'►rtn T��64 —
City: FvY- ti,E—State: �L
Zip Code: Fax:
Phone No. i U I E
Mail: Yl C
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: (
ti
Company:Inn0'Va±w)n—&nf-wChhQins;
Address:
City: 'F +` State:
Zip Code: y �S Fax:
Phone No 2C9. re
q '
E-Mail "F'wc..�.c�rc{�E� art+-,G•.�c�tr��-,cc;r�+,'��C'�-in •C.s
State or County License )'J I q 1
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
Name: _
Address:
City:
Zip:
Phon
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone: _
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
ate:
Not 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 representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an 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 imming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO NER: Your failure to Record a Notice of Commencement may result in paying twice for
improve nts to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie C my and osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with 1 er or a attorne before commencin work or recordin our Notice of Commencement.
- - - CASU FRENCH
l Notary Public - 5�alr �i
Sig tur w er/ Lessee/Contractor as nt for Owner,'.' ` Comm;,sior
W'
h4y Comrn, Expires Dec-' 1, 2oi i
STATE OF FLORIDA
COUNTY OFc c�
Sworn to (or affirm d) and subscribed before me of ✓ Physical Presence or Online Notarization
this � ay of 71 209,i by
-tl " C r'a-p--/ car ,
Name of person making/statement.
Personally Known V OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No.
(Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR PLANS VEGETATION I SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW