HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Z Vy es -
Date: /1 3 20 Z/ Permit Number:
L' LQ 1� .
0
y Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: PL lk rI i3 1 )4 (.
PR' f i , SEp 1MPf Vgy�IV# T LQC1 TI4N:
Address: 2 3 M L`- / %C R e q -') /.36y L
Property Tax ID ##: 34 / y S41 - / 7,0"/ - OoD 9 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
-- �/V _S i /- < c 30 GALS C--"L L r �z C i •�( cf9� ��v.e i
CL0SC7—
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric 1361
lumbing
Total Sq. Ft of Construction:
Cost of Construction: $ /r.3 9�•
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4 "iZF(--" D .e E
Address: 2-3 �/� / % EiZ2�^J���J $C✓i) I�
Name: At fYi','V V -t-/ v k 4- % D
Company:
AddreS .0 U
City: Pa % 5 T L.tc_I C State: FL
Zip Code: 3 9T 2-Fax:
Phone No. $-gyp - Sr 7t / - 91r3 E-
City: v� Sit C = 42.�.<_) State: -EL
Zip Code: 3 Y 99Z Fax:
Phone No 77Z - ZZ"U - 7 S 7 7
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail /iyic;O e�r Qp. �Luw1B J.� G
State or County License CFC- I 3 02Yy
It value of construction is Z500 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 recordine vour Notice of Commencement.
Signature of Owner/ essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 15A- L-.t��,1
-�
Sworn to (or affirmed) and subscribed before me of physical Presence or Online Notarization
this day of 20_ by
Name of person making statement.
Personally Known OR Produ Identification
c/
Type of Identification Produced
L'al4&= A'A-'
(Signature of Notary Public- St ofFlorida)
Commission No. (Seal)
HEATHER BURFORD
4�Y PUB
a� °�? State of Florida -Notary Public
Commission # GG 183217
`` MyCommission Expires
February 06, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 5720/11