HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z 2 Permit Number:
4
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: '�6L� ]e rac % erl 9,13N �3
Property Tax ID #: 3L(� �70 - o63 7 - DOd ' Lot No.
Site Plan Name: 1 j (�� Block No.
Project Name: V e I C
DETAILED DESCRIPTION OF WORK:
10
' Q I uJoo e��� u� e 5'w at - 1-et�lce r 6
lw► oi year, Qod bd JP ere r � P l
e
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: Sq. Ft. of First Floor:
Cost of Construction: $ P?0 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name le 1--e M CAQ U
Name: Orapeloy,vi�lGi
Company:
Address: 0,�' 10C y`
City: Ill- State: rL
Zip Code: 3yfY3 Fax:
Phone No �3 d- �eZy%
Address: A��tY V) 'dKa
City: State:
Zip Code:3y9k3 Fax:
Phone No. 97,2- o?��i'/ �3 E-
Mail: Yt A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 'am'W41am Felq6eLd1L !qwq I . fGrt/I
State or County License a L 3 ��—
iT value or consiruction is z5uu 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.
SUPPLEMENTAL �pN
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip. Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
DN LIEN LAW INFORMATION;
Not Applicable MORTGAGE COMPANY:
Name:
Address:
— State. _ City:
Zip: Phone:
Not Applicable BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 conflicts with an � applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners Association and review your deed for any restrictions which mply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform thay ae woprk
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 finanrin� ,....tom With lender nr an w_r___ _
.� .._�'J, C L'i"I"Imencing
work or recordin our Notice of Commencement. yv JU
Signature of Contra to or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF_5-r— Lve iL
Sworn tp (or affir ed) and su scribed before me of
thisjj±tday
Physical Presence or Online Notarization
of Cx_ 2011 by
a —A sr-� D or 1 ch 4 OC2 C, tJ
Name of person making statement.
Personally Known �i OR Produced Identification
os�VP e 1aiME enTi,
_
Ty e of Identification Produced
Notary Public . State o! ::cri; n
a: o Commission � GG
My Comm. Expires Jun tl 2022
Bonded through National your; A022
(S• nature of tary Public- State o orida)
Commission No. 2-9
(Seal)
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