HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: RECEDED �jermit Number:,2/or-y11- .2-
�11 1011 AUG o A4uno:) aion-i '15
Permitting Departmen J O
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Building Permit Application AUTO 9nd
Planning and Development Services A% I'L Azi
Building and Code Regulation Division Commercial Residentioe
2300 Virginia Avenue, Fort Pierce FL 34982 ���St Luei --- coots f.
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Kko �^
Address:
Property Tax ID #:
Site Plan Name:
Project Name: K CU� ti S 'iL
New Electrical Meter
- 6Q 3�-000 -.)L- Lot No..
Block No.
Additional work to be performed under this permit -check all that apply:
'/echanical _ Gas Tank _ Gas Piping _ Shutters " Windows/Doors _ Pond
J Electric !L--P-Iumbing sprinklers _ Generator ✓Roof//a� Pitch
Total Sq. Ft of Construction: `4 AVV ` Sq. Ft. of First Floor: � �-W SF
Cost of construction: $ .435o. Do o Utilities: —Sewer _Septic Building Height:
011UNER�S�EE• � � �
,� 4}
CONWTRIAWClT®R�'�"gip
Name �C Q t2 i/3'I
Name: I GLr&
Address: 1303 Rwy rs&/Yd
Company: r-Sa-5+&1-)1 n LL-G
City: I State: 1l fi
Address: 0 //,�
Zip Code: a ��lu Fax: N /
Cityy- ce4T &2� State:
Phone No. �%� �s� �' 7(d g
Zip Code: "3,-Q�ao Fax: AJ 11q
E-Mail:Ge-a4. Qa) rni(;,, ]-0) Gina
Phone No --2i a- 10 qf— 37"23
Fill in fee simple Title Holder on next page ( if different
E-Mail kJW n ay P��-
from the Owner listed above)
State or County License �t,jnC, 150g9T7
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
MORTGAPE CO P Y: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: io 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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
with lender or an attornev before commencing work or recording your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
���COUNTY OF 6 CLIO
Sworn to Or affirm ) and subscr'bed before me of V Physical Presence or Online Notarization
this�'J ay of 20AI by
Ll
44-(r 0�d r6 0
Name of person making statement.
;onally Known ,OR Produced Identification
Tyoffnldentification Produced
%i n \
('tignature of Notary Public- State of Florida )
Notary Public State of Florida
Commission N 2 �Z�� (Seal) Patricia KCollins
c 'My Commission GG 248672
or a J Expires 08/2412022
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR PLANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW