HomeMy WebLinkAboutBuilding Permit Application`All APPLICABLE INFO MUST BE COMP,. "D FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /(� 7 'y�7"
RECEIVED
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
P. I R, Al IRM R I DI I
I /M, PROVEME, IN LOCAT•
Property Tax ID #:
Site Plan Name:
Project Name: _
jut 21 1011
permitting Depa,tment
St. Lucie county
Residential
. 6'
-3)3=000)-D0C9.% Lot No.
Block No.
A rnn cA f-e P& i (o V-a s i
0 l4 d RAwlA[ sC(e-ei- raw
New Electrical Meter Second Electrical Meter
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: Sq. Ft. of First Floor:
Cost of Construction: $ 0 01 O( Utilities: -Sewer —Septic Building Height:
NERD� 1[US�S E:
ENVY4 E
CONTRACTOR:
Name 1''h 7Lo!'S01
I\
Name: `% '
Address:: 17 0 5 $ t vary+ Rd
Company:
City. r-t) i P14l-ce State:
Zip Code: 3y`) �) Fax: I
Phone No.
Address:
City:�SorG,G state: �G
Zip Code: , 39 Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Ito/
State or County License 64C /j'/ k! :y-
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.
� 1
SUPPLEMENTA C�NSTR�U lON LIEN LAW INFO MATION.
DESIGNER/ENGINEER:_ _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ftcl-x,e ]
_
Name:
Address: 'NO) Ui jcnd Sotic. to
Address:
City: 0 rb4.0 State: F=
City: State:
Zip: Z0^18 K Phone 'ID) - Q No - ILM0
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 er or an attorney before commencing work or recordilIg your Notice of Commencement.
ig to o Own r essee/Contractor as Agent for Owner
(sign e f C r r/License Holder
OFF RIDA
STAT F F ID�f 1 ' ' nl�
COUNTY OF
CO
COUNTY OF �/�j
rn to (or affirmed) and subscribed before me of
P ysical Pr s o Online Notarization
Sw 7rn to (or affirmed) and subscribed before me of
ical P es r Online Notarization
this day of 21 by
this day o - 21_ by
1p
Name of person making stat ment. PO C hi hpp
Name of pers n making statement.
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary u li
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(Signature of Notary Pu '
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Commission No. =_: (�®�51670
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