HomeMy WebLinkAboutBuilding Permit Application ' 1
All APPLICABLE INFO MUST BE Ct _-,OLETED FOR APPLICATION TO BE'ACCEPTED
Date:., Permit Number:
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ptication
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Planning and Developrrentser*.es
Building and Code Regulation.Division Commercial...... ...._. Residential
2300.Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4624553 Fax. (.772,)462-1578 CBDG. Funding .
__.
PERMIT APPLICATION FOR,
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F�R;(3Pl?QED!�� lI���O!VEN�,��1IT�LOCATI�3i�
-Address.. V. 1
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Property Tax ID#:: Lot No,
Site Plan Name:,:
Let
e Block No
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Project Name :L .
o ¢ILb�I�E;sCRIFTIONFUf%C�R L411
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New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTIONAINFORATION a
Additional work to be performed under this,permit—check all that apply:
—Mechanicat _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:$ 1, t Utilities: Sewer _Septic Building Height,'..:.
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0wNIt V'ESSEE CONTRACTOR ¢¢
Name C_ rt
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Add re r . {. B
p ny.
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City' , .. � 1c1'rr" S '
State: -Address
Zip Code: Fax: ...... Gty Phone No., _. E- Zin:.:Cacie �i .. Fax
IVlail ,..
_ _ Phone No ' ''�. .
Fill in fee simple Title Holder on next page(if different E Ntail
from the Owner listed above). State or CdUrity License
LIfvai,,ue of construction is 2500.or:more,a RECORDED Notice of Commencement:isrequired.
e"of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DES�NER/ENG111(EER._ Not Aplrcable MORTG�kG COMPANY: Not Apphcalsle
Name :.__.:.. _- ..... Name s
Address _ Address
Stafie G _ ata£e:
Gty _ _
ZIp`:. . . ... Phone G Phone:;..
FEE S[MRLhT.ITLE.HOLDER. Not AppficaEleBONDING COMPANY. �NdtApplicableF
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Name - . —
Address .._ _... . -._._ Ad ess -_
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CI i Criyr
Zlp Phone lap .......:: Phoner. ..
OIA�NER/CON�RAG�QR AFFIDVIT Applrcation is hereby madeto obtain a permitto da the'wolcand:instalfatronas indicated
t certify that:no wortcor rnstallatrorr.has,commentett prrorto,the,issuance>of a peFrnrtU
St�Lurie C!le
unty ma ripe�r entttq ghat rs l2tnt► aPer► it+ iti attt#tortFt+a prit h�oltteroildtlie scrbcCstructure
wtttcir uirih1n orate Hottteouunersso� ron rules b iaws ar a c�cosrc*crers#s fth rr3ay resicf artipmb rbif such
strurre In cortsrdeat�on of the granting of thrs requested permrt,I do herebyagreerthat t`�wrU,m alt cespects,perform th.e worth
rn accordance=with the approved,plans,the,°:FlpnsiaiBu�ld[ng:Codesantl,St.l.uue,County_Amendments:;
Theefollowing budding permit appircatrons are exempt from undergoing a full corv'curren*'review room additions,
acce`ssarystructufes,svinmming pools,fences,walls,signs,'screen;rooms:and accessor..V, -s o'airother non residential use
WARNING TO OWNER-"`Your farlure:xo 11 td't a�Natrce of_Commencement may result rn paying twice or `
improvements to£y_our property.A loot ce of=sCommenc drit must be recorded.iri the prab rc records of St '.
Lucte4County and posted orE the�obslt before theafrst Inspection Ifyou intend to;obtalrr<fnancing,consult
wlthae"der o;r an attor before-camrnerian -;wank or re-ordin our�Notice of Commencement:;;"
Srgrfaiture of Owner ee Mr" or aswAgent for Owner
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STAB OF FLORI
COUNTlC OF
Sworn to "or affrr d n .subscribed before-me of X' Physical Presence or Online Notarization
tFits- day of 20 ...by
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Narrre,_;person ing tatemerit.
Personalty KnoWp,^ OR Rriodt�ced ldenbficatron.....
Type-of-I ifrtirr Prodlr s:ed-
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(Sgnatiareof Notary Public Stateofocrda)
� Ul iota i�ubtt ;ateti�ot,Florlaa
Ctata t�riNe`H$ve�raa
Commission No. _.(Seal? My ocm i�sttoe: . ..
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REVIEWS, FRONT ,ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER "REVIEW REVIEW REVIEW REVIEW' REVIEUV REVIEUV
U . ...
ATE
RECEIVED
DATE .. ,... .._.... _.... .. ..._._. _
COMPLETED
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