HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A
Permit Number:
DI Date:
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Building Permit Application
F Plannq g and Deveiopment;$ervices:
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue Fort Pierce°FL 34982
Phone:(772)462-1553'Fax:(772)46245 78 CBDG Funding,
a PER IT APPLICATION FOR
,s. PROPOSED iIUIPROVEMENT LOCATION:
w' Address:_1a 7 :'9 !....n.
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L a Tax ID#:, 3gtq, I
p rty Lot No.
Pro
OG G Block No.`;Zl
Site Plan'Name: t�
Project Name: /"�GtY(1LG: ►`
DETAILED DESCRIPTION OF WORK.
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New Electrical Meter - Second Electrical Meterrequired)
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CONSTRUCTION INFORMATION
Additional,work to be performed. under thi's permit.—check all that apply:
_Mechanical: _Gas Tank _,Gas Piping _Shutters _Windows/Doors Pond
_Electric _Plumbing ._.Sprinklers _Generator Roof Pitch
Total Sq.Ftof Construction; Sq.Ft.of First Floor
Cost of Construction:$ aDO, _ Utilities: _Sewer _Septic Building Height
OINIVER/LESSE€: CONTR.ACTOR:
f1 Name Lalk M a rU CG t Name: cart GdL(�� YY!
Address: 1 Company:_Ch
City:_ State: Address:65Z Ss5 K V�.f)
Zip Code: i .LI t7 Fax; K* tir City;. y L -}—State: �
Phone No. a s`5.3L � E; Zip Code:3L/clk'3 Fax: Yt ( -
Mail:. .Gl Phone No77,2-3 yb_--V-Y1
Fill in fee simple Title Holder on next page(it different
E-Mail
from the Owner listed;abave) State orGounty License_
If value of construction is 250.0 or mote.,a RECORDED Notice of Commencement is required.
if value of HAVC is$7,500 or more;a,RECORDED Notice of Commencement is required.
SUPPLEMENTALCON�STRUCT ON L�EN�LAW INFORMATION. .r ' k
le n
DESIGNER ENGINEER• Not Applicable
• MORTGAGE COMPANY:. _ Pp
Not,A licable
Name: Name:
Address: Address;
City: State; City:: _.. State.:. . .
Zip: " Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not:Applicable BONDING COMPANY: ZZNot,Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:. Phone:
OWNER/CONTRACTOR AFFIDVIT:Application s.here by'made to.obtain a permit to do the.work and installation as indicated.
I:certifythat no;uvork or installation has commenced prior tothe.issuance of:a permit.
St.Lucie County makes no representation that is granting a permitwill authorize the permit holder to.build the subject structure
which conflicts"with any"applicable HomeownersVS.0 iation rules,bylaws;brand covenants that may restrict or prohibit such
structure Please,consult with your Homeowners.Association and review your deed for arivrestrictions which may"apply.
In consideration of the granting:of this requested:permit;I do hereby agree that[will;in all respects,perform the work.
in accordance.with the approved plansthe Florida Building Codes and St.Lucie County Amendments:
The following building permit applications are exempt from undergoing a full concurrency,reyiew;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 obtairi.financing,consult
with lender oran attorney before commencing work or recording our Notice of Commencement.
signature of Owner/Lessee/Cont for s Agent for Owner
I' -
STATE OF FLORIDA.
COUNTY OF 4
Swor to"(or affirmed)and s bseribed.before me of Physical Presenceor Online Notarization
this day of 20Zt bya,r
Name of person making statement.
Personally Kno OR`Produced.ldentification
Type of Identification Produced'
(Signature of Notary Public-State of Florida)
JAIMG� 2 �Y Seal a Bn NotaC�Pub is ES�i�et F1'oridz
Commission No. ) �`
� q< commission 00 22 'a
Comm.EYpim Jun 11.20'L
Bonded through Nati§nsPkbtar}Assn.
i ._ .. .. ....:
1
REVIEWS FRONT ZONING 'SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
';RECEIVED .
DATE.
COMPLETED
Rev 512ulzI _