HomeMy WebLinkAboutBuilding Permit ApplicationAll appi irAw r irdrin MIl_qT RF rOmPi FTFn. FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number: � V . 0,5().3
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial V Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-157 . 8 CBDG Funding
PERMIT APPLICATION FOR:
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Address: 120b Vj MlDWA\j WD Fr ?,0(ZL6,FC_.. 5-101,62-
Property Tax ID M 34.04 So -I 0322- Mo - 0 Lot.No.
Site Plan Name: Block No.
.Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional. work to be performed under -this permit- check all that apply:
—Mechanical Gas Tank —Gas Piping Shutters Windows/Doors Pond
VElectric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction., Sq. Ft. of First Floor:
Cost of Construction. $ (,Pr poo utilities: "S Sewer Septic ' -Building-Heigft
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Name %k1_A P_MTEVWS'GS
Name: Smg��� "KA.
company. -
Address: 2300 $igLLA v.-
ow Voqx Ptc- ce State:.r�!_,
Address: k A 2
Zip Code: 3 q Fax:
City: T---% - L&j`�S ate:
Phone No. E-
Zip Code: SS-2--, Fax:
Mail:
Phone No IS4-21WO7
Fill in fee simple Title Holder on next page (if different
E-Mail 'LO& (A_kZj&_X1t�jr
from the Owner listed above).
State or County Litense
IIIf value of construction is 2SOD or more,.a,RECORDED Notice of Commencement Is required.
If value of HAVC.is$7,500 or more, a RECORDED Notice of Commencement isirequired. II
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: Rbse Z-i -vv. 10 AR—,q '& L-k-
Name:
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Address: i,"12 C-4vv5oi-' STRc07
Address:
City:
State:
City: 5E AsT%Ar<1 State: r-L.
Zip: 3295S Phone �Z 5@l- S-72-7
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby.mad'e 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 an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu�t 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 lanrlor nr an nttnrnav hafnrP rnmmpncinor wnrk nr rP_rnreling vnur Notice of Commencement.
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Signature of Owner/ Lessee/Contra for as Agent for Owner
STATE OF FLORIDA
COUNTY OF FROWARD
Sworn to (or affirmed) and subscribed before me of X
Physical Presence or Online Notarization
this 19 day of 06019E1Z 20_V by S MV R. NAU
Name of person making statement.
Personally Known if OR Produced Iden ' 'cation
,p...... MARIOA.GOMEZ
_ MY COMMISSION # GG 153722
T pe of Identification Produced
EXPIRES: November4,2021
•
i
'. OF ;�Q• BordedThNNoU .. �164CUt�
(Signat a of Notary.Public- State of Florida)
Commission No. (Seal)
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