HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Iio>P Q , 2.62. l Permit Number:
L Wu Cm
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 1-1 i 11AJA aL 1L f2_e4'a-:- Ra LUC,L FL 31-199r:�
Property Tax lD#: 2433 X02— 1)626 0003 Lot No. 2 L
Site Plan Name: AL6"7_b r-Lz-AiCL _,vx-,7grrL Block No.
Project Name: .�.tls;�3LL PVC FZ_,WCc=
DETAILED DESCRIPTION OF WORK:
UQ 1)00L_ d3a4PLALiL:�IL 1ALE: vL) 2S Z 'L,F-- OF @i�'G 1 K[V.4t�-r
F=�jucL W i T71 2-s- `ki u uc 0/1 7rK
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: Sq. Ft. of First Floor:
Cost of Construction: $ to , L O +0 D Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name L 0 ALnAIZ6 Name: iVKLLtL' L I1�etCY
Address: Company: / Gi�L r /2iuCGr
City: 'Nii-t' - � LuCbLZ State: :-L Address: 7S7 k[Ud 67AI-77J-Li'eQx2, &LIVt-
Zip Code: .?-Y9,94o Fax: City: i'>&t7- I— Lucrz^
State:
Phone No. ?-72- &V-7 2 2-A ci E- Zip Code: .3 499G Fax:772- 1108 OL?�
Mail: A LOM7-O frees orj=jc_4-: 'd2 21..seu_,N. aLt-1 Phone No 772_ - B 12 0223
Fill in fee simple Title Holder on next page (if different E-Mail ilk! e [ 14
from the Owner listed above] State or County License C Q C 45-2 75-7
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: . Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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 an yy applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consuit 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 yo 'r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and p9sted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an agorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ ossee/ ontractor as gent for Owner
STATE OF FLO A
COUNTY OF t. Lecc 6
Sworn to(or affirmed)and subscribed before me of _ Physical Presence or Online Notarization
this day of ��✓ ,2D?1 by
Name of person making statement.
Personally Known I OR Produced Identification
Ty of identificatio Produced
lli, A Am'� V\'n I �
(Signatur f Notary Public-State of F rida)
Commission No.(J(,l ;�`'bl_�►`I(seal) ate of Florida
on
NEE
GG 929549
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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