HomeMy WebLinkAboutBuilding permit appAll APPLICABLf INFO MU SJ BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/lJ 11 I Permit Number:
ovo U cu
Cho 4
1 15' ° ° ' �<- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34981 '
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ci AY�AS Q 0(- 6lu G
Property Tax ID #: ) 30 I — G I 1 - 303 (3 - Goo :a
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
u
I
(Affidavit required)
Lot No. -�
Block No. X)J—
M
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_ Electric _ Plumbing _ Sprinklers _ Generator X, Roof Pitch
Total Sq. Ft of Construction: 1 000
Sq.
Ft. of First Floor:
1000
Cost of Construction: $ 16) oo 00
Utilities:
—Sewer _Septic
1
Building Height: 10
OWNER/LESSEE:
CONTRACTOR:
Name
Ll5 C I
Name: Se (e�I C SCC�J
Address: —7ZC)rS 0�fUS Pa'iK RjIU4
Company: C1:SCGS &Oi\Vtct
kp2i,1C I
City: ��} p%4fCy- State: FL
Zip Code: 3'4g3I Fax:
Phone No. E-
Address: C(C(LA 5w 3S"N
City: aLIfyi C State: fL
T
Zip Code: 3q of Fax:
Phone No 712- FSZF5-1a-74
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail -I-11'r66-� �Ai-kye QCOF I n(i -�zIUtic
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
with lender or an attornev before commencing work or rpcnrdino vnur Nntirc+ of rnmmanramcnt
Signature oriroe(*/Contractor as Agent for Owner
STATE O IDA �� L� C
COUNTY OF
Sworn to (or affirmed)) and subscribed before me of Physical Presence or _ Online Notarization
this2dayofQCVO1D--e'Y-
201I by
Name of person making statement.
Personally Known X__ OR Produced Identification
Ty Identification Pr duced
h.Ccfq
(Signature of Notary' tte of Florida)
,Public-
NANCY �EHOR RST
Commission No. IT 1914eal) Notary Public
o State of Florida
a Cornn*HH167992
s'Ncr re�0
E:ylres g/28/202S
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nCY J/LV/G1