HomeMy WebLinkAboutBuilding Permit App - revised Qualifier All APPLICABLE INFO MUST SE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-' Permit NUMUCr;
7 �r Ulf..='L 18
PlOn Tina and Development Services
air'idirig Cod Code RLagalotiorrDtvision Corn rnerc[aI Res iderttiaI _ L.
2300 4lirginto Avenue, fo rt Pierce Jtt 34992
Phone (777) 462-1553 Fat: (772)462-7578
PERMIT APPLICATION FOR{ —
PROPOSED IMPROVEMENT LOCATION:
to Ir4t
Property Tax ID W - i . - t(`} ,- Lot No, 11
Site Plan Name: A C 3Iock Nu- 3
Project Narrla- fy-% b "
F_
DETAILED DESCRIPTION OF WORK:
- - �. -I j
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply{
I/M ochanical Gas Tank 6d5 PI ing 'Utters
"d❑ws/Doors _ Pond
Aectric X6,nbing Sprinklers ,Generator x Roof C1 1 - Pitch
Total 5q. Ft ofConstructinn{ _ Sq. Ft of First Floor; yj j 11
Cost of Constructlon;$ + ( 00 utllives: —Sewer 25eptic Building Height; ! ' Q&C
OWNER/LESSEE: CONTRACTOR:
` _ 1
►�r�r�res� SVl� SL, ,+ �1 J. C �0�j 't,e Company; k IV1 C,J/)S�-r�.r� .fir }3.�it�-1 :LA VIJ w-
City{ 23L ' LA I_-t State:L Address; stir �k�t'�'r_�t. � � �� �' � 'I'[r i e?
ZIPCode; & Fax; C[ty; I?+ S I .L ,t State. r,
Phone No.. � ���'� � Zip Code; ������ ' Fax;
E-Mail; r f Ef CM i = rhone No t 11-?
Fill in foe s1mple Tltle Holder on next p4sgo ( if diffcrcnt C NlaiI C4-,1 01 1
from the Owner listed above) State or County ticense 2kc� I
If veilUe of LUN1bki MUM I I5 Z300 LP nMute, d RICl7WEU NOtILN Of Ctsrrltt LAMPrnen[I� requIred.
If value Df HAVC is $7,500 a more, a RECORDED Notice of Commencement Iti required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN RJENGINEER. Not Appl cabIL- MORTGAGE COMPANY: _ Not Applicable
Name:' lame: -' L 4 'T
Address: , L e Address: �f J
City: + 3 .t State: City: , f ��
ZIP: !. 3 phone 77.2 - ?I J` ) Zip: 3J,�ir Phone: C -
FEE SIMPLE TITLE MOLDER: >( Not Applicable BONDING COMPANY: X Not Applicable
Name; Name.
Address: Address.
City: City.
Zip: Phone: Zlp: _ Phone;
OWN CONTRACTOR AFFIDVIT: Application is hisrehy made to obtain a permit to do the work and insta Hal[on as indicated,
�certify that no work or instaIlatlon has.rommonrod prior to tha wwance of a psrrnit.
St. Luc le County makes no re rasentation that is granUng a permit will authorize the permit holder to buIld the Subject structure
which conflicts withonx appl1Gable Homeowners Assoc latlon rules, bylaws of and covenants that may restrict or Prohibit such
structure, Please ccnsut with your Homeowners Assoc latlon and review your deed for arty restrict IDns which may apply.
In conslderatian of the granting of this requested permit, I do hereby agree that l wIII, In ail respects, perform the work
in acnvrdance with the approved plans,the Florlda Building Codes and St,Lucie County Arne ndrnents.
The following building permit applications are exempt From undergo;ng a full conturrenay review'room additions,
nttessory structures,swfrnrming pools,fences,walls,signs,screen rooms and at:CeSSory uses to anottier non-resIdentlaI use
WARNING TO OWNER: Your failure to Record a NOUCe of Commencement may result In paying Notice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on thie jobsite before the first inspection. If yore intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
5iBnature of Owner/L"see/Co ntrktor as Agent for owner
STATE OF FLORIDA
COUNTY OF � 1 . tij-,(r. IC-
Sworn t (or affirmed)and subscribed before me of Physical Presence or_ online Notarizat Ion
th is i day of.'t 1 L ii r f i.ta c - 0) by
-
Name of person makine statement.
Personally knowr, v"" OR Produced Identlf«cationttlit��u��ttN
Type of Identification Produced *150 +1r ',
(SlOature of!Votary Public-State of Florida)
Commiss Ion No. (I (I l +q 9 (Sealy � y � ACrGY�f411f z'
A.
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DATE
RECEIVED
DATE
COPAPLETE1)
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