HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z/0/1—f Permit Number:
W ;114z
Building Permi Application
Planning and Development Services
Building and Code Regulation Division Commercial Resid e ntia
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: A)k) lcl1A-71-4Wf
PropertyTaxlD#:
Site Plan Name:
Project P'ame:
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
ONSTRUCTION INFORMATION: r g
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ a
Name (JA►" � rs5' 1V6A1Z) L&d
Address: /Zd ��✓ 1v1,f/i�lL�
as Piping
Sprinklers
_ Shutters _ Windows/Doors _ Pond
_ Generator _ Roof Pith
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
City: Lvk 6% State A/ -
Zip Code: �Y990 Fax:
Phone No. '%72- �y3'07,�-y 772--3yl-zLOy
E-Mail: J r Ala)j i 6&,Q� e, Cry 4k, •C04A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C'?f%A/L1'&SJ /�/6t''rq
Company: Ouf te7TAda%f ice.
Address: lil z- 5?J (f 0 L,/06-N 44LEE-
City:. PxLot C,* State-/�-
Zip C, le: 3Y9iv Fax: 77 Z - 3 7 0"�--"�'
Phone No '77 z` 2-60
E-Ma i p 4i 04
State or County Licensees �-
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.
ER/ENGINEER: ✓ Not Applical 'e
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:_
Address:
City: _
Zip:
Phone:
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 :he 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 'odes 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, sigr screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a F mice of Commencement may result in paying twice for
improvements to your property. A Notice of .ommencement must a recorded in the public records of St.
Lucie County and posted on the jobsite before: the first inspection y 24intend to obtain financing, consult
with lender or an attornev before commenciriwork or rec rdi o Notice of Commencement.
ignj3ttu`re of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF /7
STATE OF FLORID
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Preser or Online Notarization
this //'� z@36 by
P ysical Prese or Online Notarization
this day F-L by.
,day of
of
Name of person making statement.
Name of person making statement.
Personally Known C� OR Produced Identification
Personally Knowny OR Produced Identification
Type of Identification
Type of Iden ' ication
Produced
Prod ce
AWL
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n a t Lke of Notary P, ; of F1418 larK{
=?' = Commission # 06181477
= Expires(�atgh
ignature of Notary . . - 0"atTOMPAWP,OGG181477
Expires: Marsh 2022
Commission No. :'*= 27, 2022.,
Commission No. ; �"=
thrkr Notary
�i ` Bonded thru Aaron Notary
,ondetl l
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COMPLETED
Rev. 5/6/20