HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - COMPLETEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO DE A<;<;Cf"TCD
Date: ():gcbec 4,21:521 Permit Number: ________
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!i' Building Permit Application
Planning and Development Services ReSidential---7><~"--__ Building and Code Regulation Division Commercial ----
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding ____
PERMIT APPLICATION FOR: 5r\
Address: -....:......;:~~-=-..!-!.~........:::--Io......u..lL!ao:IT~:::::!....!:~::L..l...L....o~::I!:..<!...lf---!.......=!---'=~~5::L!.7_______
PropertyTaxID#: 4~O 2-501-0 '3 Lot No.___ _
Site Plan Name: ______:;--__________________
Project Name: GOhZaJeYMOCCi..\e--S
Block No. ___
I DETAILED DESCRIPTION OF WORK:
New Electrical Meter --£..X....::...__second Electrical Meter______ (Affidavit required)
II CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank _ Gas Piping Shutters A Windows/Doors Pond
~Electric ~ Plumbing _ Sprinklers Generator X Roof Pitch
Total Sq . Ft of Construction: IGJ <is , Sq. Ft. of First Floor: _q..:....:5~5L.-______
Cost of Construct i on : $ L{a~ao .-Utilities: X Sewer ~Septic Building Height: ____
OWNER/LESSEE: CONTRACTOR:
Name 5u ~ LL-C. Name: NeJ.:Q.y Cro$UC...Q®1 :I}x: ..)2=1
Address: \51 Ne.+--He-:s Blvd · Company: AA CXa:.. Ma±o~ ~
City: ~e.n~ ,&qCh State: H..Address : lOiIo/ 5 .CXean 0-.
Zip Code: .3-¥l57 Fax: _______ City:\, ~\3eoch State: FL
Phone No. E-Zip Code: ;t-fJ57 Fax : _______
Mail : Phone No 7 72 -229-'143 5
Fill In fee simple Title Holder on next page (if different E-Mail ijac,k'(g Ak\-~.CQ}yJ
from the Owner listed above) State or County License----ly'--.!::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.
SUPPLEMENTAL CONSTRUCTION liEN LAW INFORMATION:
DESIGNweNGINEER: _ Not Applicable
Name: t::J:Z'W VI b B-ctie..bi-_____
Address: Yl7 ~~U+~<.J-iL.
City: iSh..2U,ft State: .£b
Zip: Phone -n2"'2"87'" -n ?Se(
MORTGAGE COMPANY:
Name: f
_ Not Applicable
Address: fI. ~) !l.
City: ____....,--I~_+I ..Ll-9'...!...----State: __
Zip: ____ Phon: _________
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: ~ Address: 1\ r !\
City: 7'1 z:J:
Zip: _____ Phon: __________
BONDING COMPANY: I _Not Applicable
Name: _
Address: ____-1l\~I_+_/ _;~~'-------
City: ___-==-=--,...!:V -+f ....:,.f1--=.,.\ _______
Zip: _____ Phone: -..!....I _________
OWNERI CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instaUation 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 build ing permit applications are exempt from undergoi ng 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 attorney before commencing work or recor ding vour Notice 0 f Commencement.
~l~ntfo'OWn.,
STATE OF FLORIDA ~. LUG\€.COUNTY OF
swo~(or affirmed) and subscribed before me of
this day of Ck';J-rher: ' 20U by
XPhysical Presence or __Online Notarization
MClLA:: MfHn ~
Name of person making statement.
Type of Id n fica on Produced i I
pe"on'IIG~OR Pcoduced Identlfi",;on __
J ' fJJ:;Aj~~ ~
(Signature ( f Notary Public-Statelof Florid~
Commissior No. (Seal)
...i:.fX~~~... KATHLEEN GANNON [':'A>~ MYCOMMISSION#GG914400
,.~. ~~~; EXPIRES: January 18, 2024 .<~~~!~~;.., Bonded ThIll Nolaly Public UndetWriters
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Rev 5/lU/l.l