HomeMy WebLinkAboutAPPROVED, UPDATEDBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !�"' / ^� l Permit Number: /O CI -0a?
» y r1 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
PE RM IT APPLICATI OWFOR:
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Address: laoo N. Yls'( 4Z,bieaf
Property Tax I D#: Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter second Ele-c cal Meter (Affidavit required)
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping, _Shutters _Windrows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roofl Pitch
Total Sq. Ft of Construction-_ Sq. Ft. of First Floor:
Cost of Construction: Utilities: _Sewer Septic Building Height:
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Address: ,� > :_:r `.. ':.�'_.,';'- Company:
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City: — :�1'°i l= ., ; r"State Address:
Zip Code: �ax:}'`'t-'�i'" '`;h City: c State:
Phone No. 22A 65q 'r oo* 78 Zip Code: Fax: Al
E-Mail: A-,Vg /C;ggJ, Q��2�17/L.1� Phone No
Fill in fee simple TWIA7olcler on next page (if different E-Mail
from the Owner listed above) State or County License
or
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.
TOWN
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1601
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DESIGNER/ENGINEER: _Not Applicable' MORTGAGE'COMPANY: _Not Ap 'licable
Name: Name:
Address: Address-
City: State: City: State:
Zip: Phone Zip: Phone:
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.
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 permif`-w'ill:authorize the'permif F oldler'to••"build the subject'structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrictor prohibit such
structure.Please consult with your Home Owners 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�b.ef&e the'first'inspectiopf ifQyou,intend to'obtain financing;consult
with lender or an attorneybefore com men cin work.or r6ccirdin our Notice of Commencement.
Signature f Contractor=or Owner Bo deras-a plicable` - - -=- - - — -
STATE OF FLO Djk
COUNTY OF
Sworn at or affirmed and subscribed before me of � Ph sical Presence or Online Notarization
( �)___�" y
this�day of a� 2C8� by
Name of person making statement. -
Personally Known OR Produced Id tification��
Type of Identification Produced
(Signature of Notary,Public-State of Florida) ?`
ft
Commission No. ^- Z�( (Seal) Nz '9�so " Monfe
cQ ,Notary Public
z '-'-State of Florida
?Comm#HH025672
El Expires 7/30/2024
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEATURTLE` MANGROVE
-COUNTER REVIEW,. REVIEW REVIEW • . REVIEW, F._. REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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