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HomeMy WebLinkAboutLabranchePermitPack All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: L LUCUL l� J i.I `` ' 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: )cc 1 ia+ion PROPOSED IMPROVEMENT LOCATION: Address: CpOLD Property Tax ID#: 1:30 1 OD33 L G� Lot No. Site Plan Name: LQ_ c u-�C� ��GY n l T + Block No. Project Name: DETAILED DESCRIPTION OF WORK: l� New Electrical Mete Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: Additional work to be performed under this permit—check all that apply: 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: Cost of Construction:$ 1 Oa .00 Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Address: ` a Company: , City: ��-� f>ycc Statef-. Address: r Zip Code: —y- Fax: City: 1 r State: L Phone No. I l E- Zip Code: Fax: Mail: Phone Fill in fee simple Tile Holder on next page(if different E-M from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ff valno of HA►rf is C7 z;nn nr mnrP a RFrnpnFn Nhtir of f nmm—e—nt:c e.,..:—a SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: 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 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,wails,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 ith lender or an attorney before commencing work or recording our Notice of Commencement. Sidn-atffre of dwiW7 Lessee/Contractor as A for Owner STATE OF FLOT11 COUNTY OFF ('l�� Swor e�'(�1r affir nd subscribed before me of - Physical Presence or Online t �j y n Notarization this!day of 20by Name of person making ss tement. Personally Known Y OR Produced Identification ���NtlrlNt�ryt� Type of Identification Produced `\�.s``GNY G 04-f (Signature of Notary Public-State of Florida) _ A q y 's'•. vUBL Commission No. ,C"1 q�1 r`Aea11 o C a'�'� Q/ril FL REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev _ Boundary i1 Survey i f 1 10 BLOCK r•14.�14 '7 7 � t � E MOE '' �a89`,'r6'20'E. ia.,sY[M3 bus rr ea�•x,aKa x�sg 589 5h?Q"£ 190;Q0'(P� " � � 1' f`y#P $t'rE`r+G{ �7 kC '.�.'!".cx•.�w..�:..V...:.� :� .,., ty, � 9Vi.RY � � i aplf pxtt 4Fg7f1' k^ gA? 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