HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
17 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: l o) A'rT iNirl,
Property Tax ID #: (-,)) [ ' 5 D I - 6017 - 000 _5 Lot No.
Site Plan Name: 1TAt c- Block No.
Project Name: b07i.S�' "%(.7rre 5
DETAILED DESCRIPTION OF WORK:
S ic1l ; n to 1 %56)kG— — —
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be perfoi coed under this permit -check all that apply:
_Mechanical _ G: is Tank — Gas Piping _ Shutters
Electric — PIL mbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 5 Q0ID i U
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof _ Pitch
Utilities: ! Sewer _ Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name 1 Cl1i5(� `�Jvi�S i
Name:�—
Address: Act R"7 1Nrl , I Ikt- t Lt_Au--I
Company: C
city- State:
Zip Code: 34 l5l Fax:
Phone Nolb 3 0 335 - 5cI S E-
a�
Address: •?iCX_
City• `"W' State: L
Zip Code: 332 7f) Fax:
-�
Phone No (%�'�/� y'Iq)
Mail: ci--tbrr e5 ifq` o(a i an 'Corn
Fill in fee simple Title Holder on next page (if different
E-Mail �yrv�- S PAC 0"f- ,C
from the Owner listed above)
State or County License L
IVO UC W1 u.m2Ocrucxwn is cauu or more, a Krk umutu ivotice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL COS STRUCTION1 �J.EN LAW INFORMATION,
DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY:
Name: M _ . _ Name:
Address: _ _ _ .. _ _ Address.
City _ _ State: City:
i Zip: PhonEh_ _. Zip: Phone:
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not: Applicable ; BLINDING COMPANY: � Nat Applicable
Name: _ Name -
Address: _ _ _ _ ___ Address: __ ____-
City:. ___ ._ City:
Zip: Phortaa•Phone:
OWNER/ C014TRACTOR ilFFIDVIT.' Application is hereby trade to obtain a permit to dc, the %York and installation as indicated.
I certify that no work or install tion has commenced prior to the issuance of a permit.
St. Lucie County mares no rep esentation that is granting a permit will authorize the permit holder to build the subject .>tructure
which conflicts with an applicable Homeowne!s Association .rules, bylaws or and covenants that rriaey restrict or prohlb.t such
structure, Please consult with four Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the grantin of this requested permit, i do hereby agree that I will, In all respects, perform the work
in accordance with the approv �d plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: loom additions,
accessory struc!:ures, swimrnir g pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Y pur failure to Record a Notice of Commencement may result in paying twice for
improvements to yOL r property: A Notice of Commencement must be recorded in the public records of St.
Lucie County and pos fed on the jobsite before the first inspection, if you intend to obtain financing„ consult
with lsanrl»r nr an nttr rnpv hpft;rp. rnmrnencine work, or recording Your- Notice of Commencement.
Signature of Contractor - or" Owner Builder as applicable
STATE OF FLORIDA,,
COUNTY OF. . _Kta si 1 i. r° ..__.....__. ____....._
Sworn to (or a►ffirlined) and s libscribed before me of Physical Presence or online Notarization
this ` O+ day of ' ' ' ._._ 20.,a by
Name of person making statgment.
Personally Known C IR produced Identification
'type of Identification Produr d_,_,_,____,._..__ __._»__....._._._
`'.-._....
�•--C•—�____—
w..,_._......,�.
Mom,,,.. .»...._..,_�,_.,...wd........»..»,.„._......,.,.,..».......,..._.,......._,,.....�.�.»...,».
(Signature of o'ary Public- $, tate of Florida)
Commission No. _. (Seal) �oPl'us Notary Public State of Florida
Thang Phu
a 41 My Commission GG 975932
Expires 04/05/2024
REVIEWS FRONT ZON114G - jj SUPERVISOR PLANS VEGETATION Y 1 SEA TURTLE
COUNTER REVIEW I REVIEW REVIEW i REVIEW REVIEW
MANGROVE j
REVIEW J1
RECEIVED
DATE
COMPLETED
Rev 10/12/11