HomeMy WebLinkAboutPERMIT APPLICATION_2751 TALL PINES STAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ICE '7 if�6 ' Z 1 Permit Number:
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L 0 � ° ° [_i Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: c-
PROPOSED IMPROVEMENT LOCATION:
n —w 11
Address:.a('
Property Tax I D #: , 721- 2011 00 j Lot No.
Site Plan Name: Block No.�
Name:
Project
DETAILED DESCRIPTION OF WORK:
it Cl t. C t tC
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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 Constructi .: Sq. Ft. of First Floor:
Cost of Construction: $- Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ^1 <<< j
Name:
Address:! ll� !d'r���
Company:
City: -$-• i Cam. State:��
Zip Code: Fax: �1
Phone No. _77 — r _55 i.�d" illy
Address: 12t ! ��Ic ��,- i 1$x720 `7t
City: � Stater
Zip Code: �7�� Fax:
Phone No_7_;��_�3�7� "vim
E-Mail: �'�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail .I Y_wr \i�i' +f' 'a` ` �
State or County License d66
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 MORTGAGE COMPANY, _ Not Applicable
Name: Name:
Address: Address:
City: State:
City: State:
Zip: ti Phone:
zip: hone
FEE SIMPLE T TLE 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
Association rules, bylaws or and covenants that may restrict or prohibit such
which conflicts with any applicable Homeowners
Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
structure.
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,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
Commencement must be recorded in the public records of St.
improvements to your property. A Notice of
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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 5- I vc rL
Sworn toaffirmed).and subscribed before me of Physical Presence or Online Notarization
this dayof 20I by
Name of person making statement.
Personally Known OR Produced Identification
Type. f Ide tificati produced
rye"' PEA -
_(Si ature of Not -'y Public- State o Iad)`�`�' — —
c00O'K, Notary Public State of Florida
? Stephanie Faye Douthitt
Commission No. ( my commission
HH 166709
T`'�r` Exp. 811912025
FRONT
ZONING SUPERVISOR
PLANS
VEGETATION SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS
COUNTER
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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