HomeMy WebLinkAboutcuker permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: _
� o LUYQI�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential_
CBDG Funding
PERMIT APPLICATION FOR: eY00
RRnp01qFn IMIPROVFMFNT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
-nCC)-3
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No. � - 3
Block No.
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 r. Pitch
Total Sq. Ft of Construction: z_C00 Sq. Ft. of First Floor: 2600
Cost of Construction: $ 1 j 2 -00 Utilities: —Sewer _Septic Building Height: 2-0
OWNER/LESSEE:
CONTRACTOR:
Name S
'
Name:b f
L iS VCM
of 11
Address: 2 q 16, I Y
Company:
City: lei �� State:16�
Address:
Zip Code: Fax:
City: )
State:
Phone No. E-
Zip Code: ,-2,_ PFax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail e—
i
from the Owner listed above)
State or County License t
(�
IIf value of construction is 2500 or more, a REGVRDED Nonce or Lommencemeni is requireu. I
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
nFSiGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Name:
Address: State:
State: City:
Zip: ____________ Phone:
Not Applicable
BONDING COMPANY: 4Not Applicable
Name:
Address:
City:
Zip; Phone:
lication is hereby made to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: App
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation owneis
sgranti gapeation mil bylaws or a d covenants holder
hat maybestdrlct or prohibit
such re
which conflicts s with any applicable
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
lt in
WARNING TO OWNER:oyourYour failure to
property. A Notice of Commencement must be a Notice of Commencement re recorded paying hpubl c records of St.
improvements twice for
y p
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an poste a before corn work or recording our Notice of Commencement.
Sign Pture of Owner/ Lessee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of I I e 20,4 by
Name of person making
Personally Known OR Produced Identification
Commission No. (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
KATHERINE HAVENS
MY COMMISSION #GG165030
EXPIRES: DEC 04, 2021
I0 �? Bonded through 1st State Insurance
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
SEATURTLE I MANGROVE
REVIEW REVIEW