HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED !� (l
Date: r `Q l o� 0 a- I Permit Number: l9) o q �o
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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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: C{ 5 0 0 5 0 Ce q n 0 � r�,) P�Jilk7 leeci CA FL ALP` gLs-7
Property Tax ID#: L-fs Ca- 60 d - 0 6 d —Da/0 0 ~� Lot No. '
Site Plan Name:--'CC; 1 a17 t Cv D V) �I 0M I'll 1'IJ ynq Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
D M I ._ _. I '✓' I�G1 �Pw (S C) C yr-\e— Cl yy -\
New Electrical-Meter,- (Affidavit required)
CONSTRUCTIOWWORi17l"QN
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: $ S 00,D b Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name GNU eO .4I- SGLG S Name: C h ri,5 fD ph er Ly i/
Address: q.5 00 50 U1-h nCeail Dr. Uh/'hydl Company: CNL 6u_i'/C/i'j0 of f,ac:fD�'�
City: Devi sei . lgeaC State: FL, Address: (a 5 U,/ ,J C( C/GCy'n 10J4Ce-
Zip Code: 3 y q,S'7 Fax: City: 101, Sf. Lick i�e- State:E
Phone No. E- Zip Code: 'bLt q&(a Fax:
Mail: Phone No -7 2 ;L a o 1 -71() 3
Fill in fee simple Title Holder on next page (if different E-Mail cVl 1 b 11 d ov�G� �vI f
from the Owner listed above) State or County License C 13 l, O 3 g0 SP U
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMP Y• _Not Applicable
Name: nZ 1 Name: IV
Address: Address: IN
City: State: City: State:
Zip: Phone 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 conflicts with any 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
withip,ndgr,or an pnorneV before commencing work or recording our Notice of Commencement.
Lesseejontra
ctor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirm )andgd before me of Physical Presence n
thizay of 20_s)J by
Name of person making statement.
Produt d I enti c do
Type f Id tification Produced
(Signature of Notary
Pu c-((State of Florida)
Commission NJ MA A� Y) (Seal) :?o�;�YP;°��: HELENADUMICH
Notary Public State of Florida
o Commission#GG 929993
oF�°'` My Comm.Expires Nov 7,2023
••Bonded through National Notary Assn.
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DATE
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DATE
COMPLETED
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