HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
'90� Permit Number:
Date: v f
,a
LLllL
4 ,� J- id
p�^ 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: t,1i� 11 l �l
PROPOSED IMPROVEMENT LOCATION:
Address: OaD Drl V10— _TISI F, 3-InFa�z
Property Tax ID #:3_1 "51 - oraa `'r-
Lot No.
Site Plan Name Ra
Block No. �!
Project Name: f Jt:w + S
DETAILED DESCRIPTION OF WORK:
L L
New Electrical Meter Second Electrical Meter (Affidavit required)
I 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:
C�
Cost of Construction: r� rJ� C Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name IS Name: �l'l `'' l
Addree�ss �ior.]ar r Compan
ll)
City:-t` - �� �,G -Q. State: F Address 1
Zip Code: C?'� Fax: City: G.47 is rc_.e,
State:
Phone No. E- Zip Code- Fax: __ 9 aC8C L6
Mail: Phone No 7a - 3 -'
Fill in fee simple Title Holder on next page (if different E-Mail Im
.�
from the Owner listed above) State or County Licensee.' l SOL4
9 I
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGGINEER:
Name: 4-'Ore
Address:
City:
Zi Ph ne
FEE SIMPLE TITLE HOLDER:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Not Applicable
State:
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, 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 or an attorney before commencing work or recording our Notice of Commencement.
%6ature of Owner/ Lessee/ lgotractor as Agent for Owner
STATE OF FLO!fI
COUNTY OF F - 'ccI'e_
Swo�r�to (or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this � day of r , 20� by
1 rr1 `)rr3)[ %
Name of person making statement.
Personally Known 13 OR Produced Identification
Type. Identification Produced
nature of Nota u is State of Florida)
Commission N (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
�? SABRINABUTLER
MY COMMISSION # GG 163728
P? EXPIRES: December 8, 2021
c d 0 Bonded Thru Notary Public Undermfters
ZONING SUPERVISOR PLANS VEGETATION —I SEA TURTLE � MANGROVE
REVIEW ` REVIEW REVIEW REVIEW I REVIEW REVIEW