HomeMy WebLinkAboutBUILDING PERMIT APPLICATION . .....-------------------
' All APPLICABLE INMQM BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
-- Building.Permit Application
Planning and DevelopmerrtSelvices a
.Building and Code Regulation.Divisidn Commercial_ ReSldeCltial
2300 Virginia Avenue Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(712)462-I578
PERMIT APPLICATION 1=0R: p�cv1eroL�. tl"Ga�A %�
PROPOSED-IMPROVEMENT LOCATION:
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Address: II
II Lot No. CV
Prop"Tax lU#:,�
Site Plan Name: �: �"'t 6 Block No.
6i _ 6 '
Project Name:
DETAILE'D__=_DESCRIPTION'OF WORK: .
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New Electrical Meter rl Second Electrical Meter ..
CONSTRUCTION,INFORMATION:
Additional work to be performed- under this permit—check all that apply: l
_Mechanical ' _Gas Tank Gas Piping _Shutters _.windows/.Doors Pond
Electric Plumbing Sprinklers Generator Roof Pitch
Total.Sq.Ft of Construction: /y Sq.Ft.of FirstVoor4l
Cost of Construction:$ S/7G0. Utilities: Sewer" —septic Building Height:
l -0
fJV11NfRLESSEE; CONTRACTOR:
Name Name:
Address:3/l0 !� L� Company:
City:fig: -State,� Address: a
Zip Cade:., �3 Fax: City: ooz, S�`o�1s %p State: L
�.; 9�;�
Phone No� 4-3 _f ,'� /� Zip Code:�,,, Fax:
E-Mail, Phone No�
Fill in fee simple Titre Holder on next page{if different E Mall,,b 8 G a A a ® CJ,7*?a4 r awyn —
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from the Owner listed above) State or County license C�4/A?•���•�i��
if value of construction is 2500 or more,a-RECORDED Notice of Commencement is required..
If value of HAVC is$7,560 or more,a RECORDED Notice of Commencement is required.
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FDESIGNE�R/IENGMEER:
ENTAL CONSTRUCTION LIEN LAIN INFORMATION:
_Not A plica' I- MORTGAGE COMPANY:; Not Applicable
Name:
Addr ss: �, Z.Q #poi Address:
City: t
��P State: t— City: State:
Zip:. I Phone /. j—,3'�b�o Zip: Phone:
FEE SIMPLE TITI E HOLDER: /Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
-
Address: I Address:
City: i'
Zip: Phone: 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 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.
I.
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 qftan attorney before commencing work or recording our N tice of Commencement.
SSS
Slgnatur wrier/L e/Contractor as A�ggda t for owner Signature of C e o der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF af L_Ltc; P COUNTY OF St. Lu.c,4 e,
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Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
. Physical Presence or Online Notarization 4o PhysicaI Presence or Online Notarization
this2�tday of 20�Al- by this-J` clay of D2C.,ert4-IW - .zolL by
0.rr�1 r71�4� 1
Names e o arson Q�
P g statement. Name of person malif statement.
Personally Known �0 OR Produced Identification Personally Known ek2__ -OR Produced identification
Type of Identification Type of Identification
Produced Produced
ignature of Notay Public-St r p on Ndtary Pubhe State of Flon ( nature of Notary Public-S
��(( Bunrne Merritt Woodard r v Notary Public State of Ronda
Commission No.n Q S (�ommission HH 039626 r' erntt Woodard
,P( Miles09107no24 CO mission NO.
' +�r d• + li�"y"�"o�mission HH 039826
~'+ ° Expires 09107/2024
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED !'
BATE
COMPLETED
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