HomeMy WebLinkAboutPermit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Development Services
Building and Code Regulation Division Commercial Residential )c V,X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address: '324 S X4 c ra 09l t/l3
PropertyTaxlD#: agaZ. toot- btnC( -OOO-q Lot No. _
Site Plan Name: l A. 1 ,A Z 4 n Block No. 49
Project Name: "'j'_i„,�.c��F %'X . �% n
`G ckn a 0 kA i C G r V. i Y.,r r% &<4 ��k} g�7 i��' = rl/L( C•yF'
New Electrical Meter Second Electrical Meter
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: $ (,a (a !A 6'. 071
Na
_ Gas Piping
Sprinklers
Shutters
(Affidavit required)
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address: 3Aa �+�Af0. ✓� i�6.. �!y0
City:r),.4 A-40 reL State: %l_
Zip Code: 3 Lk�$ 2 Fax:
Phone No.-1-12-Ct1I- U (.'C6 E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: .J e FCr"
Company: C.t n C�S�rD/►-� r t.t)rvG,i lT nJq%
Address:�f!
City: ,'eD w.;N,_ „ o 4l & do State: L
Zip Code: 33v(aq Fax:
Phone No i'12- &Oo -4y,KtC
E-Mail J, ca rvt \10— �-C hr , M -- r . LeEP►"
State or County License CH GoSj�g -7 l
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.
n
NEER: — Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City: _
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 ranting a permit will authorize the permit holder to.build the subject structure
which conflicts with any applicable Homeowners5ssociation 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 ures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNI G T OWNER: our failure to Record a Notice of Commencement may result in paying twice for
im rove ents to urproperty. A Notice of Commencement must be recorded in the public records of St.
L ie Co my d s ed on the jobsite before the first inspection. If you intend to obtain financing, consult
Ith Len er a t me e commencin work or recording our Notice of Commencement.
a Lessee/contractor as Agent for Owner
Si ofZORIDA
ST E OF
C NTY OF
Sworn to (or affirmed) nd subscribed before me of Physical Presence or Online Notarization
this � day of e 2014 by
x FV-rGtA U%,AS�,rbtw�
Name of person m ing statement.
,�RRv Pue<� DULCE MARTINEZ
Person y own $— OR Produced Id e fication
2� c Commission # HH 119702
Type Ide tification roduced_
r o Expires May 10,2025
9fFOFF�oe\ BonMTin BudgdNOWYServices
( ure of Notary Public State of Florida)
Commission No. (Seal)
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MANGROVE
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DATE
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DATE
COMPLETED
Rev 5/20/Z1