HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v
Date: ��`\a1a, Permit Number:
j� �nJ���a (� RECEIVED
o� NOV 12 231.
Building Permit Application St.Lucie Count,
Planning and Development Services Permlttln
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: .
67® P �
Address: '
Property Tax I D#: 1101 " ' D 2 t c) " ®O 0 f Lot No.
Site Plan Name: rv-,a ft;o Block No.
Project Name: XAo ecifI-y
DETAILED DESCRIPTION OF WORK:`,:.
r \ l
k6,-C 'F P 9,C, gcvsty
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: 3(v o Sq. Ft.of First Floor:
Cost of Construction: $ 2 2 S O O Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: ., °'..CONTRACTOR:`.
Name_/ eAe— Name: —
Address: �702_ R_A6L., CA Company: ",�I C.4C& _zc
City: �mrP i�'.CI(� State:L Address: $2$C� �U'
Zip Code; 3gg s t Fax: City: Qry 64 tvt[.J. _Stater
Phone No. "�'' 0 " -t+ Zip Code: 311q 2; `7 Fax:
E-Mail: Phone No 7U—2-1 G -1 Y w
Fill in fee simple Title Holder on next page(if different E-Mail IfC.,o t0tA r'XVCe,. p(v 5
from the Owner-listed above) State or County License �g L/ ct
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.
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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 "pe
erty. A Notice of Commencement must be recorded in the public records of St.
Lucie County athe jobsite before the first inspection. If you intend to obtain financing, consult
with lender efore commencin work or recording our Notice of Commencement.
Signat?reOwner/Lessee/Contractor as Agent for Owne
STAT FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of ysical Presence or Online Notarization
this .27 day of 00oln L 1 20.11 by
Name of person maki:�Muced
Personally Known Identification
Type of Identification Produced
Aim
(Si a ure of Notary Public-State pf Florida)
Commission No. (Seal) HEATHER BURFORD
01os re�,
;State of Florida-Notary Public
_* Commission # GG 183217
i 91y.OF F`OP�`� My Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETED
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