HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L f ..__S_ - Permit Number.
C(:Ak u
Building Permit Application
Planninc and Develotlntent Services
80dingznd Code RecjulorlonDiuisiun CO11 mercical�,�_ Residential
2300 Virginio Avenue,you t Pierce FL 3,1982
Phone:{772)462-1S53 Fars:(772)462-1578
PERMIT APPLICATION FOR: �eC f i f CS �--
PROPOSED IMPROVEMENT LOCATION:
Address: z4 So 1 O�-ctn j_f A\j e- far;-
Property Tax ID 0 �L 1`?.- !]t} ri ' DCiC I Lot No.
Site Plan Name: Block blo.
Project Name:
DETAILEID DESCRi[PTION OF WORK: 1
.�_ L cati01 ,` c a 1 a �v ct L�ti a � r� n
New Electrical Meter Second Electrical Meter
CONS T RRJCTION I;NFORMATRON: _
Additional work to b•Performed under this permit-check all that apply:
_Wlechanical __Gas Tank —Gas Piping _Shutters Windows/Doors Pond
_Electric —Plumbing _Sprin€:lers —Generator _Roof Pitch
Total 5q.Ft of Construction: 5q.Ft.or'First Floor: _
cost of Cons truction: Utilfries: —Sevver _5eptic Building height:
OWNER/LESSEE: _ CONTRACTOR:
U-C Name: c:Lr..� rti+t�._9�7`•
a Address: 2t->5Rf Company: � '�` w�� 'G r►�
City: C`1 r�.n� r 1�5 State: IN Address: Cer-
Zip Cora: Z a Fa:<: City: fT. �e'trG State: L
Phonpt:c. �� - �� z 5 Zip Code: 3AY Fax: �Gq-41,—3�
� n i l Phone No�Y 'Y_ ` �Br ,
Fill in fe-:simple Title Haider an ne: page(if different I E-Mail S'f'y occf"e1�
from the Owner listed above) State or County License G E 3 bb 7
i
If value of cons':ruction is 250D w more,a RL-CORDED Notice of Commencement is required_
If value of HAVr_is$7,50C or more,a RECORDED Notice of Commencement is required.
SUPAL MENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERICNG1N E,11 Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City State; City: State:
Zip: Tone- Zip: Phone:
FEE SIRS PLE TITLE fiOLDER: Not Applicable BONDING COMPANY: '—Not Applicable
Name: ! Name:
Address: i Address:
City:_. !! City:
€ Zip: Phone: _ Zip: Phone:
OWNER[C:QNTRR',CTOR AFFI DVIT:Application is herehy made to obtain a permit to do the viork and Installation as indicated-
I certify that no work ar in tallation has commenced prior to the issuance of a permit.
St.Lucie County makc-,no representation that is granting a permit will authorize the permit holder to build the subject structure
Which is it conlict vri_is ar-y applicable Home Owners Association rules,bylaws or and covenants that may restrictor prohibit such
structure. IIeaie can stilt—1th your Horne Owners Association and review your deed for any restrictions which may apply-
I In considcc;ation of th,i;rr:riting of this requested permir.I do hereby agree that t vidl,in all respects,perform the work
in accordz lice-,k-ith thr-ap;rroved plans,the Florida Building Codes and St.Lucie County Amendments.
The folloevng building permit applications are exempt from undergoing a full concvrrencyreview:room additions,
accessory<_rtuctures,sr,inwnuig pools,fences,walls,signs,screen rooms and accessory uses to another non-residendat use
WARNING-'TO OWNER-Your failura to Record a Notice of Commencement may result in paying twice for
p improvements to your property.A Notice of Cornmencernent must he recorded in the public records of St.
Lucie County ar#rI hosted on the jobsite before the first inspecti -!f you intend to obtai nancing,consult
with:ender or an sttorne•y before commencing or recpr your Notice of C ncement.
Siinattir of Owner,:Lzs_eelContractor as Agent for Owner Signature of ContractorfLitense Holder
STATE 3 FLOR STATE OF FLORI
k COLJNI"!of .LU Gf C-- COUNTY of
Sivorn to(or aff-srmcd)a.;d subscdbnri before me of Sworn to(or affirmed}an subscribed i;e'ore me of
icafPrese.tic'r.•r Online:.\otarization �PlysicalPresen or Online Notarization
this J- da;o; ��(;�'tifg,!_,2` this day o€ ,2{ 3Y
t
Ida col ;ersan m- in a�ricn{• DCATALINEame of person making statement.
; LiSA?,. rid c/ "so,
ISACATALINE
rsonaNy KnownOR Proc[cicerl[di- so blit State of Florida
Type of lrlenri:icati ? . My Comm,Ex02 peof Identificationroduced Co ssion p GG 942330
Produ ---Sotrded�tFrrough Nass My Co Expires Jan 21,2tJ24
` Bonded thr u National Notary Assn.
i (Sig,ah_:e of Notar- f-w.lic-Stattr of Florida J (Signature of Notary Public-State of Florida
Commist.cn i o. (Seal) Commission No. (Seal)
REVtEV'S I #ROPJ ZOWN IC i SUPERVISOR PLANS VEGETATION SEA TURTLE EMANGROVE
COUAr*EH REVIDAI _ REVIEW � REVIEW � REViEW REVIEW � REVIEW
DATE—
can,iat.eTED__,___
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