HomeMy WebLinkAboutAPP MFill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State: Z
Zip Code:
Phone No
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zip cooe: 33{/3
Phone No *t - 211-Sl?3
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State or County License
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AII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Perm it Number:
sli [(.].cl]ll
Building Permit Application
Plonning ond Development Services
Building ond Code Regulotion Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phonet 1772\ 462-1553 Fax: 1772], 462-7578
Commercial Residential x
CBDG Funding
Address: t\\e -\e
Property Tax lD #:
Site Plan Name:
tf5il - t6j- o(fa.q - ooo -?Lot No. lg
Block No. _
Project Name:AC 39.5t
C e r5,
New Electrical Meter Second Electrical Meter (Affidavit req uired)
Additional work to be performed underthis permit - check all that apply:t Mechanical _ Gas Tank
Electric _ Plumbing
_ 6as Piping
_ Sprinklers
_ Shutters
_ Generator
_ Windows/Doors
Roof
P ':nd
Pitch
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: S z aio Utilities: _Sewer _Septic BuildingHeight: _
lf value oI construction is 2500 or more, a RECORDEO Notice ol Commencement is required.
It value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is requited'
PERMIT APPLICATION FOR:
OWNER/LESSEE:
lali. l
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION :
CONTRACTOR:
PROPOSED IMPROVEMENT LOCATION :
SU PPLE ;"4 E iiTAL CONSTRUCTION LI EN LAW I N FO RMATION :
DESIGNER
Name:_
Add ress:
IN EER _ Not Applicable MORTGAGE COMPANY:
Name:
_ Not Applicable
Address
State City State
Zip: __ Phone zip Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY
Na me:
_Not Applicable
Name:__
Add ress:Add ress
City: _
zip Phone Phone
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify thal nc work or installation has commenced prior to the issuance of a permit.
St. Lucie Corrrtv makes no reDresentation that i\ srantins a oermit wili authorize the oermit holder to bu;ld the subiect structure
which confli.ts w.th anv aoollcable Homeownerstrssocia"tioh rules. bvlaws or and covenants that mav restrict or o16hibit such
structure. PleJse consult with your ttomeowners Association and ieview your deed for any restrictiois which mai apply.
ln consideralion ofthe granting ofthis requested permit, ldo 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 slruatures, 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
imprcvements 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. lf you intend to obtain financing, consult
with lender or an attorne fore commencin work or recordin our Notice of Commencement.
Signature (,1 O,vner/ Lesse e /Cont c s Agent for Owner
STATE Ot' FLORIDA .-\
COUNTY OF t4_1L^)tr1c$.^(','
Sworn to (:)r aff
this _[ rlay of
irmed) and subscribed before me ofo+-+. .20?I by
___-:fPhysical Presence or _ Online Notarization
-bcv ZCrr
Name of pcrscn ma ng statement
Personally Kxown -qL OR Produced ldentification
-
Tvp e of ldentif,.ati roduced
(n ublic- State of Florida)
(Seal)
REVIEWS
DATE
R ECEIVEI)
DATE
COMPLET ED
IVIANGROVE
REVIEW
VICENTE Y LEAL
Not!ry Publlc - St e ot Florid.
Commlrrion, HH 019j79
l{y Comm. Etptrer S!, 3, 202{
Sondad throuii N,tion!l ior.ry A3sn
SU PERVISOR
REVIEW
CV 1
FRONT
COU NTER
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
City:
Commission No.
Zipl
City:
xl,+iQ*
'iWri
ZONING
REVIEW