HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q' ( q I @, � Permit Number:
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 CBDG Funding
PERMIT APPLICATION FOR: Ci w a- -
PROPOSED IMPROVEMENT LOCATION:
Address: c'M
V1Q.r-CP
Property Tax ID #: �3 C4 1 c) (il - c) Cl y ucn - `1 Lot No. 3 t�i,
Site Plan Name: �\ \ mC� i Block No.
Project Name
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 35 La OL,
(Affidavit required)
_ Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name�
Name: Eac_ E V- C)
Address: ll K ea-' I 7p,C(
City: �pl ck_ r (� ;P State: FL
Company: - r
Address: 1-1 y1C
ZQ tr LLL
�
Zip Code: 3�4CV� c-4 Fax:
Phone No.')'_1 a Q � 1 blq h E-
city:__�C-44- f)� U'Xck{'
Zip Code: v 4q ':�4 Fax:
State: Ft
Mail:r li _ 1iso(lA_ - nc
Phone No —1-1
Fill in fee simple Title Holder on next page (if different
E-Mail
State or oun License 31 Z,\'1
from the Owner listed above)
vauo VwnauuLAwn ib vvv or more, a KCI-UKuru notice oT 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: _je� Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: ✓Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: /Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
V VV IVCK/ LVIY 1 KAL I UK A"IUVI I: 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 and applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lende or a Pore rr)mmpnrino wnrk nr rornrrlina „ni it Aln+; ,o .,f / .,.... ..
S' r of Owner/ Lessee ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY
Sworn or affirmed) and subscribed before
me of Physical Presence or Online Notarization
this �y�ay of % k.,M-y— 20aL by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No.6F63N',�q -i (Seal) �` YP;'�k� CHRISTINABRIGGS
t * Commission # GG 3002%
101023
' ExpiresFebruary 2s«wun
'? a°TMu
e t@t►iwn
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev