HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
91ro L�lyi�L1J5 p ..
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P -"y 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: aX14 (t__3 I l j-f _
l PROPOSED IMPROVEMENT LOCATION:
Address: G cl °S l hore s ! ci -Q,
Property Tax ID #: I LI a,3 — Sl._plls " O®C)L4 _00C) ° Q
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
�L 3HNq
Lot No. I
Block No.
(Affidavit required)
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Cost of Construction: $ 6?.3, 00 0 . 0 0 Utilities:
OWNER/LESSEE:
Name I VCU&4__'�' I-- f
Address: SQ-0 IS SnO u ®w I C.I-
City: _Se,I b T,_State: IhT
Zip Code: q '� 3 I � Fax:
Phone No. 5 _eLo • 3Qa • l R® E-
Mail:(XUJ a Vet. the �+I DrYOIQL . C
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Roof Pitch
Sewer _ Septic Building Height:
CONTRACTOR:
Name: CAI
Company: t-.I' OA t iIfv (1
Address: QQ0 NCtco 02
City: a - State: F L
Zip Code: N� Fax: ]`70-4LD4-1g7-0
Phone NoATTQ q ' U 0qD
E-MaiL� 1`O°9-�—IfIln-1( 'i0�WL ii�
State or County License O4— _J—_1
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.
I40
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MOT Y: 1 -" Not Applicable
Name: er1 C, k �Il t L I I"1
1-�
Name: I -Ti d� bC - i'4
Address: Ala -k.-I^ n—V
Address: 050 S _(�_'Vit
City: f l -e f' e -p, State:
City: i 2A'State: 1=1_..
Zip: 3q qS0 Phone i3q
Zip:�4 Q R I Phone: - 1-ia•41D1 , gQDU0
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.
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 or an atto-rney before commencing work or recordino your Notice of Commencement.
l a�f
t
Signature of Contractor - or - O r Builder as applicable
STATE OF FLORIDA
COUNTY OF S �- Lila I
Swor o (or affirmed) and subscribed before me of % Physical Presence or Online Notarization
this 8 day of2Q 1 by
ac_
Name of personi making stat ent.
Personally Known 1/gsOR Produced Identification
Type of Identification Produced
(Signature of Nof4ry Public- State of Florida)
s� ,p" Notary Public State of Florida
Commission No. LGr 3'S0Q,5( al) AP Ginger P Hester
My Commission GG 330259
a wd Expires 08125=23
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
eev-1.2121