HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
J�y. LUVL 1S
O d v t
P . a 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: fbo — I 1 �- 01 ,—O( JU --7
Site Plan Name: T-P- & i was K
Project Name:
DETAILED DESCRIPTION OF WORK:
la
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
Lot No. 777
Block No. 11) (o
(Affidavit required)
Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1%(/y Sq. Ft. of First Floor: )Zdy
Cost of Construction:$ T5 �(gO Utilities: _Sewer _Septic Building Height: )r-
OWNER/LESSEE:
CONTRACTOR:
Name 19T h4 CA afNr
Name:
(
�t42
Address: —bi'Ud 1lV1e Z
Companyitt
City: OV� \A%Ce Stater
Zip Code: Fax:
Phone No. �,1_ i b�i 'i�1s E-
Address: t, y
City: NOh 5c,vState, ,
Zip Code: e'M I Fax:
b
Phone No DOU - U-70 - 42 U Z
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail CG i
i i
State or County License CBC I-z48ZZ
,T value oT construction Is Z500 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:
Name:
City:
Zip:.
FEE SIMPLE TITLE HOLDER:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Name: _
Address:
City:
Zip:
Phone:
Applicable
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 any 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, 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 attornev before commencine work or recording vour Notice of Commencement.
Aid
Signature 6f Ow er/Contractor as Agent for Owner
STATE OF P Gffi9-6VU"'5I\'1
COUNTY OF
Sworn to (or affirmed) an subscribed before me of " Physical Presence or Online Notarization
this _ day $t
of 201� by
Name of person making statement.
Personally Known Produced Identification
ati 1� ��
Type Ident' 'a3fNot
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(Sin ure State of N•
XPIRES
Commission No.:;*. OFR all
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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