HomeMy WebLinkAboutBuilding Permit Application • (( I t
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Aril APNCABLE liVfQ MUST BE,COMPLETED FOR�APPLICATIO Tti BE ACCEPTED
Date:--- -�'— � Permit Number;
&� Build ng P6m tAppI cation
- FtonnMy:�rn+�0eve/oprnent 5ervc�s _
'Bullding andCode Reg`ulotron Dluislon Commercial Residential:
24,0Q Virgjhid Rvenue,Fort Pierce FL 34982
Pi7ane (77,2}_462 1553 Fax` (7,72)462-2578 CBDG FUl1Cllflg
PERMIT APPLICATIQN.FOR,i
PROPaSED 1'MPFtQVEl1%1`FNT IQCATION
z' Address:
L ,4PropertyTaxlD--#. Q3' J �/ ..... Lot:No. J f ?4
Site Plan Name: A 44 Block:No.
Project,Narrie;
DETAILED DESCRIPTION OF WORK':.
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f
New Electrical,Meter, Second.Electrlcal Meter.. {Affidavit required}
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CONSTRt C?I0N;INFORMATION' Y
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Additional work to be performed under this permit—check:Al that apply:
4— echanical _'Gas Tank as,Pi ping . wShutters ^vindowslQgors Pond
Electric Piumbing,• _ _Sprinklers _ Generator Raof "Pitch.
4 '
Total.Sq.Ft of.Construction; - Sq.Ft:of First Floor:
Cost of Construct tan:,,$ - Utilities:; , 'Sewer' __ Septic Building Helghts
C}.WNER/L.ESSEE . `CONTRA-TQR: ' P
Name f�fame . '
Company., ; .
city: , .t a State:' Address: P
Zip C6de: '1 t`' l=ax: CityS-Z 0A State::E,�=,
Phone.No. ' . " - Zip C 6 Fait:
E ade
Niatf: C °t tAIi&A. � 1 f�� Phone No ,: I
Fill irrfee simple Title Fialder.,on:next poge{if•different E-Matt A
lfrom:the:Owner iisted.;above}. State or County License -' '4 t e
I t
if uatue of coast uctI66 is 2500`or,more,a`RECQRDED Notice of.CommencemenY is ree quire&
I if-Value of HAVE Is.,t',7yS00'ar more,2 RECORDED Ndtice of:Commencement is.required.
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SUPPLENIE JTA-CONSTRUCTION LIEN LAVtI INF.ORMATIQN,
DESIGNERIENGINEER _Not Applicable MORTGAGES COMP.,ANY:. " •- Not Applicable.
Name 's ctt ON 'Narne:
Address. iI # tom _ °`Address
City:
Stater City State.
Zip; . Phone
ZIp< Phones
p;
FEE SIMPLE TdTlE WO:I ER"t Not Applicable ,BONDING-COO' PANY:,' ,�,:*10t Applicable
Name, Name: t
Adefress: Address:
Clty:
Zip Phone: Zip: Phone:
"
Ci11VNER/_CONTRACTCiR AFFif?VIT: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 thatis ranting"a permit will authorize the permit holder to build the subject structure
which conflicts with any,applicable°Homeowners, rules,bylaws or and covenants that may restrict or prohlbtt wch
structure.Please consu t with your.Homeowners;Association and review your deed for any restrictions,which may apply.
in accordance with th6 consideration of the approved:' lans,the Floridvested permit,
Bu lding Codes'and S .agree that l un in mendpe %nt perfoi m the Work
nd.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-residentJai;use
WARNING TO OW14'ER:Your failure to Record a Notice of,Co:mme'' merit,may result in paying twice for
improvements'to your property;A'Notice of Commencement must,be recorded in the publi:e records of St.
Lucie Count
and posted on the Jobsite before the first inspection. If you intend to obtain financing,Consult
i with lender or,an"attorney before �+commencing work or recordingyour.Notice of Commencement.
Signature of Owner/LesseeJContractoras Agent for Owner
STATE OF,.Ft ORID
COUNTY O ?� •, rt:.��.1 i
Swor or affirm e and subscribed before me of zlhvsical Presence or Online Notarization
this. day of 20a by
t l Le
Name of penon`mak ng'staternent.
Persr>naliy Known OR Produced Id entification
T pe g iyentification Produced
,(Signature of(Votary'Public-State of Florida)
('� �• (/( ff,� Notary Puvr'State of"Fkxt04
CommisSlon Nc`ti-" " + � c eal} Patricia K COUIna:
° My,Commission GG'248572
eiss� F—vimsow2412022
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REVIEWS i Rt}NT xf PIING SUP.ERVISC3R PiANS 1.EGETATIQN, $EA.7URTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW- REVIEW REVIEW REVIEW
DATE e
RECEIVED"
DATE: ,
CQIAPLETED.
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