HomeMy WebLinkAboutbuildingAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L-L..-'.CLL
- 1 Pk.
Building pp 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:
PROPOSED IMPROVEMENT LOCATION:
Address: .y-
r�
Property Tax ID #:O9 - - oco S - - Lot No.
Site Plan Name: ROStsy -) _ Block No.
Project Name: Ds5 MC 4-7
DETAILED DESCRIPTION OF WORK:
'-1, 1 o c c
New Electrical Meter 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; (Pao Sq. Ft. of First Floor:
Cost of Construction: $ z ; Uov Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: j
Company: I [ r.J fto•7
Address: 2)1n Rc f�(� C.
City: c State
Address: `'i� IS G71 rug iVsL
City: Fort_ Ti ev-cam Stater)
Zip Coded-tc� Fax:
Phone No. E-
Mail:
Zip Coder d u u FFax:_719- 3� 3-2390
Phone No -33623OS
Fill in fee simple Title Holder on next page (if different
E-Mail aA2
C- C)OA
State or County License C&_ IS() qqi ,l
from the Owner listed above)
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:
DESIGIKR/ENGINES • Not Applicable
Name. f �Df t4 I'
Addass; C CA
City: i kf� ���r it�R`� _ State: I
Zip:_4yLA[ pf Phoneys(6-
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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.
5t. 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.ar and covenants that may restrict or prohibit such
structure. Please consult wrth 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 attorne_V before commencing work or recordin your Notice of Commencement.
Sigl ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLOFUDA
COUNTY OF'-t
Sworn to (or affirmed) and subscribed before me of �� Physical Presence or Online Notarization
thisf - day of 20Q l by
Name of person making statement.
Personally Known �% OR Produced Identification
Tu.pe_of Identification Produced__
of Florida)
Commission NJ � % �(Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
SABRINA BUTLER
MY COMMISSION # GG 163728
EXPIRES: December 8, 2021
Bonded Thru Notary Public) u� �^'��
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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