HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ti `L Lu(.:L:L� -
,
19
1- L c u c Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce £L 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: I Q _ / v a'P
— 7
PROPOSED IMPROVEMENT LOCATION:
Address: 3 a
�711Gt /�
Property Tax I D #: C'I Oct / � a o R 3- - d
Lot No. a 6 a-7
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
�Gr ��� P v ,SLjn4 Coo �r�C� 'InS�all now IIlQ
}Cl(
Gtnc� k) Hole c IaHw,of.�
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 _ Windows/Doo
s _ Pond
_Electric _Plumbing _Sprinklers _Generator �L Roof 4
! Pitch
Total Sq. Ft of Construction: 69 3 Sq. Ft- of First Floor:
Cost of Construction: S /6v 000 Utilities: _ Sewer —Septic Building
eight:
OWNER/LESSEE:
CONTRACTOR:
Name rl e O
Name: r t Q'A p(1a
Address:63Z3 L,&r%q(,Q, 5�,
Company-f Su CegT+
00�rr1
City: i-a e" 171 Q,r ( a. State: E
Address: 16 5t✓ 1�' \ w\
S)'.
Zip Code: 39g63 Fax:
City Gi�sc. Stater
Phone No. -77J - 6/75"" 75 6 %
Zip Code: 3�� �1 c`��l Fax:
E-Mail:
Phone No 7 -��r --9-) O
Fill in fee simple Title Holder on next page I if different
E-Mail oA ,tTl L. LC
qt�\q, k .0
State or County License C I
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. �-
If value of HAVC Is $7,W0 or more, a RECORDED Notice of Commencement Is required.
DESIGNER ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City:
Zip: Phone Zip: Phone:_
State:
FEE SIMPLE TITLEHOLDER: 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
nstallation 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 authorise the permit holder to build
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may r
structure. Please consult with your Home Owners Association and review your deed for any restrictions which
a subject structure
trio or prohibit such
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 add
tions,
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 payinj
twice for
improvements to your property. A Notice of Commencement must be recorded in the
Lucie County and posted on the jobsite before the first inspection. If you intend to obti
with lender or an attorney before commencing work or recording our Notice of Commencement.
public records of St.
in financing, consult
Signature of Owner/ Less / ntra as Agent or Owner Signature of ontr ctor/Li n Hold r
STATE OF FLOR STATE OF FLORIDA
COUNTY! COUNTY OF
me
otarizau
20 by
5 rn to (or affirmed) and subscribed before m c) n Z S n t r affirmed) and subscribed before
P ysicalPrese eort� r_OnlineNotarix ic3 w _PJayslcalPrese4geor_Online
this day of f�_., 20Z0 by �_2 this day of 1g/�/ 2
C a
o'ovo
'Name
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71 33 Z
Identific
of person making statement.
Name of person making s atement. Z xJ65
pp �
Personally Known �' OR Produced deaUPersonally Known T OR Produce
Type of Identification c\Type of Identification
zm'
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Q yNProducedoProduce ti Q mo(Signature
of Notary Public- State of FI rida } — �(Signature of Notary Public- State of
i
Commission NoZ�E_A_ (Seal) Commission No. f
Ida)
(Seal}
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