HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I I Permit Number:
90 I Building Permit Application
Planning and Development Services
Building and Code Regulation Division Comrllercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: McAGA Ro _ QtC
PROPOSED INIPROVEIMENT`LOCATfON -
Address: O it . Pteil R .3
Property Tax ID#: — �p�2" 'q' _ ICJ Lot No.
Site Plan Name: Block No.
Project Name: � � ` r . mar►(Q l eo(Ael
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DETAILED DESCRIPTION OF WORK f
fe-MQ\rk IQ -e.� VS�V A -C n0f; C_'Irld Wg CLC I rO W t*V1
New Electrical Meter Second Electrical Me i i r (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: MJ14 Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height: Z p
OWNER/LESSEE ": l CONTRACTOR:
Name L. M Upr1 r • Name:
Address: f4a3 K%cil nn Or• Company:
City: k PIw.YC State:0 Address:
Zip Code: 3L+g82 -Fax: City: State:
Phone No. Z1a 5DI 40 E- Zip Code: Fax:
Mail: ditl a IrLv . -F1O(+e5 oyah00•CC Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW iI�NFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _XNot Applicable
Name: Name:
Address: 1 Address:
City: City:
Zip: Phone: II Zip: Phone:
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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 pe I mit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association 'ales,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, Idol�ereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Cddes and St. Lucie County Amendments.
The following building permit applications are exempt from ulr dergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,scr en 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 Co''nmencement 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 or an attorney before commencin lyvork or recording our Notice of Commencement.
(Z M qr/o OgLe&l
tgnature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF -�
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Sworrto(or affirme.-.dl and subscribed before me of I"Iq Physical Presence or Online Notarization
this I l day of 2Q6 1 by
LAma Ix".6 !L a'cLa��
Name of person making statement.
Personally Known OR Produced Identification
Type oNdentification Produced
I
�I
(SlgnaAre k Notary Public-State of rida) -
Commission No. " r�S' 1�Qf2750St1
(Seal) =tea tS
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE i
COMPLETED
Rev 512-012-1