HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-4- a :` mil
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:3:;k V� S . . % a l v ';�
Property Tax ID#: I L4 a,5- LOS; - L
Lot No.
Site Plan Name: Block No.
Project Name:
!DETAILED DESCRIPTION OF WORK:
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:
OWN_E/1RAESSEE: CONTRACTOR:
Name l all l-• c 0 k Name: L- 45 S':lJz
Address: I`6' t to SW Company: D >c S-Furm �c k�vEic,�`�(o s�r �S,Lie
City: V-��A State:` L Address: '&u—D
Zip Code: Fax: City: U""' State: I-
Phone No= E- Zip Code: 3 H�;S 3 Fax:
Mail: Phone No 9 L-I I - L4 3-A 3
Fill in fee simple Title Holder on next page if different E-Mail
from the Owner listed above) State or County License=-e S 3 a S z:�,
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 CONSTAOCTONVEN LAW INFORMATION;__ _T _
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 'c `, r� t~~� ' Name: -
Address: Address.
City:_` .` ._ State:. . City: _- - .._ State:...-..__
I Zip: S -i 11 !-4 Phone-1 L.CC'�1Zip: __ _Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable ` BONDING COMPANY: Not Applicable �^
Name: Name:
Address: ( Address:
( City: -- _ ` City:
Zip: Phone: f�f Zip: Phone:
OWNER/CONTRACTOR AFFIDVkT: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 grantingg 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 1 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-residenbaf 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 5t.
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 your Notice of Commencement. .�__
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Signature of Owner/Lessee/Contractor as Agent for Owner
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STATE OF FLORIDA
COUNTY flF_._ __ c � •_ 44.., i
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of •24___.by !�(
{ Name of person making statement.
Personally Known ',' OR Produced Identification
j Type of identification Produced _
i
(Signature of Notary Public-State of Florida) : Commission WOOD
#HH 156395
Expires July 21,2025 i
Commission No. - (Seal) °F',°'' ftd dTtnTroyfainlnsurenra8003057019
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RE FRONT ZONING
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
Ik-- COUNTER LREVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW
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