HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ct 201 z I Permit Number:
�"CI
p 440 P' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial _ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: LOff kP e
Address:
Site Plan Name: D C'e YA gg14 tk Y K3 ® u f i rysnn m, 1 t n t` Q n Block No.
Project Name: Q(A u va B`t- CaY h o v 2 t°°3 o r k—t'a
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical
✓
Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Gas Piping
_
_Sprinklers
Cost of Construction: $
_Shutters
(Affidavit required)
_Windows/Doors _Pond
Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name ,E>
Address:))4{S{
Ct Und t
(}lo-err-W (zj
V
the
Name:
Company(,6MO14-ee 'Lld'cFriC.
tytC.
City: `Lt SS 4 Pvtrvi'e$
Zip Code: ° 1 fl a Fax:
Phone No.
State: L.
E-
Address: Ut'6'1 Ee boLr.+-i �Vl G l Y a(
.
City: f tl3 et
Zip Code: 2 cf
Phone No "I'l
; h a
Z, •38c,� -OS33
State: EL.
Fax: 'I'll % SS - ZLI { I
Mail:
Fill in fee simple
from the Owner
Title Holder on
listed above)
next page (if different
E-Mail OAa v
q e ✓t i& {-- 2 i Vt le. fat { e
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
wtG.
ens
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not
Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
nr,
Signature of Owner/ Lessee/Contractor a ner � ;4tw;v" o`. COURTNEY E REGAN -
(;; 0s Notary Public - State of Florida
STATE OF FLORIDA commission a HH 028294
COUNTY OF �N�(A (/i (� IC/ UQ ✓ OrF}4'My Comm. Expires Sep 19, 2024
t„ Bonded through National Notary Assn.
Swor c$(or affir d) and subscribed bef r me of Presence _ Physical or _ On ine o n a
thi l day of by
20Z7
of person
Personally Known li
Type of Identification
of Notary
OR Produced Identification
Commission No. n9.8ZgH (Seal)
REVIEWS
SREVIEWOR
VREVIEWON
SREVIEWLE
MREVIEWVE
(COUNTER
I REEVIEW
I I
REVIEW
I
I
f:T�g10TADI7
COMPLETED