HomeMy WebLinkAboutBuilding Permit App - BrennanAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
` 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: J'JUq \Y
„ 1�V
�
PROPOSED IMPROVEMENT LOCATION:
Address: Uc1 %J ►) Holy-10 AV, 1.
.I.y
Property Tax ID #: 4' ZU ' 304-
b022 - C5[](]—
Lot No.
Site Plan Name: �lf� V)Y 11.'Ln
Block No.
Project Name: Y Ir1rlO'n
DETAILED DESCRIPTION OF WORK:
.s At }rer cY
New Electrical Meter._ Second Electrical Meter (Affidavit required)
TONSTRUCTION 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:
_.
�r'�
Cost Construction: $
nn/!
of �[J�-� Utilities: _ _. Sewer _ Septic Building
Height: �7
OWNER/LESSEE:
CONTRACTOR:
Name G�CI
ame: r 1
Address:
ampany: I IC t_.C�C�CC
City: Clt S
_
Address. ❑ L%�k'i�'Cl�
�-
City: ��(���
State:
Zip Code: Fax:
Phone No. +}} - E-
Zip Code: ti`-t " _ Fax:
Mail:
Phone No
E-Mail
YY?
Fill in fee simple Title Holder on next page (if different
State or County License c. LAPOULA
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:
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone;
Not Applicable
State:
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.
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 orfiapratt(Kney before commencing work orrecording our Notice of Commencement.
Signature of ne Le s /Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF oaam
Sworn to (or affirme ) and subscribed before me of Physical Presence or Online Notarization
this !L3 day of V Y Yl 20_1 I by
roLtt 5_� Ice
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced l
ure of Notary Pu4fic- State 6TTForid
Commission No.A VM30u6 (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Notary PvOle State of Florida
Ciare Marla Heveron
MA IIII i rl 183i4p o0
Exp. 101712025
ZONING SUPERVISOR PLANS
REVIEW REVIEW REVIEW
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW