HomeMy WebLinkAboutBuilding Permit Application-BortnickAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
LULL Le ..
L � ��
L L C, V,� c L, n -- -- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 4/9 7ah1
PROPOSED IMPROVEMENT LOCATION: G,
Address: ,9YOCo fih 6-.(lqGr� �Ur�
Property Tax ID #: Z.Z??—1?O/-0D,S-7-047 rQ Lot No.�(�
Site Plan Name: Block No.
Project Name.
DETAILED DESCRIPTION OF WORK:
Ia
10
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical ✓as Tank k'_"GasPiping _Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ A/Z'�• dti
(Affidavit required)
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name e_ / dyJ C
Name: /;"14_
Address: -EL ,�lG/ �i'CG�►f/%�¢ /�%
CompanyeIC o0zk!* xl}r'�
,/
City:A/tf �/.` �i�� State.
Zip Code: -TYWa Fax:
Phone No.r,?E-
Address: %qsy A/ V-191-7,C/C yli;*Cf
�l�/�•
State:
City: State:
Zip Code_74/1 /97 Fax: eo `"7l7
Phone No 7Z,2 -A -42�e
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail i'' .%
State or County License
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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State. -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 conflicts with an 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
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Own e Lessee/Contractor as Agent for Owner
STATE OF FLORID
�
COUNTY OF 41'�/i�
Swor5t2jor affirm d}j� nd subscribed before me of �hysical Presence or Online Notarization
4FGlp
this/5- day of 20,Vby
Name of person making statement.
Personally Kno n 1, OR Produced Identification
Type of Id ication Produced
zz'eo� r G
{ ' na
�a ►.' JAMES W. FOETT
o
Comm $inn _ WIYCd;MMISSIONMO32673
o`= EXPIRES: January 21.2024
offl?r S i Thiu No" i Ur&rw i!
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