HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
j �s,i}FYY'�"it» X. Y
' 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: (26 w
Address: iVW k-o v�' { I Prce l � 1l (!
Property Tax ID #: Q401 f5'.i Cf { 00 U - D Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
(Affidavit required)
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: C10 U Sq. Ft. of First Floor: Cl CQ 0
Cost of Construction: $ l �P "1'55 Utilities: Sewer Septic Building Height: i
OWNER/LESSEE:
CONTRACTOR -
Name Xrilc1 upoyN`IlxY {
Name: CViG�.
?Ur'Y1StJi
Address: (D1 <? 3 t}ti' Tit (rc) T� UA
Company: Ccwd'wa
CrAr it S
City:1V''A 12jYv e' State:`-L
Zip Code: � 6'o Fax:
Phone No. " t 11, $ (1S` O(p E-
_ _
Address: 1 } CAVIJ1061 (J�C (rt"
City:
Zip Code: -UTO 17
Phone No
State: IV -1- —
Fax:
MaiO') (, UfA 1l > U
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail JU S`O0 , S
--
(W, 6 —7—
State or County License
C -)C
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required. II
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN /ENGINEER: _Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
NameName:
.. _A 1.1.•i In i. I n✓ f0 Arlrlracc-
City: Y16 mate:
Zip: Phone
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
City: State:
Zip; Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby mace io ootam a perm..l U.- W � o • ,,,-�••-••_.. __
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
...� ^ nrrlina .,nair Nntirp of C'rlmmencement.
with lender or anattorneyDetWe LUTIMIUM11 115 wv�
Signature Own / Lessee/Contractor as Agent for Owner
STATE OF
COUNTY OF �2 ✓(^
/
Sworn to (or affirmed) and ubscribed before me of V Physical Presence or _ Online Notarization
WOW ✓
this �day of 20Z�by
M l oha ( 1 JhMAU
Name of person making statement.
Personal Known ✓ OR Produced Identification
Type of ntification Prod ed
(Si at a of Notary Pu F o ida'J•, �%
co : EXPIPES
Comm on No. o�A
Dec
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SUPERVISOR
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VEGETATION
SEA TURTLE
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
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REVIEW
DATE
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DATE
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