HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPIIL-4D FOR APPLICATION TO BE ACCEPTED -
Date: 4n 115422
Permit Number: 9// -OS2�7
° ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 4K
2300 Virginia Avenue, Fort Pierce FL 34982 v,4C�,
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID;
Site Plan Name:
-7
12
Project Name: (r- -6 a^ f/Gt�i ,✓�LL�vs� S h ��
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
(Affidavit required)
Lot No 7 �Gz9
Block No. 1
_Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: f'
Cost of Construction: $ Z�7S a Utilities: _ Sewer Septic Building Height: JQ
OW;NER/LESSEE
J .. -x
x.t ,.�..r;r,A;nrF+r-;#r -Ft., �..,✓'w '
CO<.�NTRAICTOR
Name ri d C-,
Name: —DLC
Address: �&4,( � K G_15 2o
Company:
City:State: r—L
Address:—?,
Zip Code: Fax:
City:State:
Phone No. E-
Zip Code: 5q9 �{ Fax:
Mail: 1;ry
Phone Now Z! G S—S-5�
Fill in fee simple Title'Holder on next page (if different
E-Mail f C0 ti oe , ca M
from the Owner listed above)
State or County License —G /_ Zz7S
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
.F,k :.:9%�.� .,, ..wi.si_<-: �u'„r"a,g�,::
SUPPLEMENXTALy'CONSTRUCTION IsE`NIAWII,NFO,RATION
5:b`',r�,. 4�....'3"C
�"fYu3x1'P'`y�"...w�;#.r!'.' to a:
"t� II
,.La§� .$xF: .`r"m'J.,. S�R,`?.Y.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phon
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPA :
Not Applicable
_
Name:
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 grantigg a permit will authorize the permit holder to build the subject structure
which conflicts with an
�r applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 on an attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Les ee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Ff c7� cL
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this I 6i day of 20_2J by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
onft-i
F1ZZpt
(Signature o ary Pu ' - ate of Florida)
;P$��.,, Notarlf olsslonitGG.xp«gs
Commission No. (Seal)
Gom Comtniss�4 2p23
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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