HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP
Date:
��Y. Luy
Planning and j
Building and C
2300 Virginia,
Phone: (772)
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
aU-L 2.3. Zazi Permit Number:
Building Permit Application
?velopment Services
de Regulation Division
,enue, Fort Pierce FL 34982
�62-1553 Fax: (772) 462-1578
Commercia
CBDG Funding
PERMIT A PLICATION FOR:
-L Arir c
PROPOSED IMPROVEMENT LOCATION:
Address: .Sifictc-OPLY baiUL- Fcv, PtL;i_cLr- FL-_15IL2
Property Tax I DI #:
Site Plan Name _
Project Name:
DETAILED [
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F&xi cc
New Electrical
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Q'
2UCr= 1~47tiCI�' leVs7-11TLL
i.-I.s 77/3 LL P v L I Litt C
Residential
Lot No, 72
Block No. 7
ESCRIPTION OF WORK:
CA— PJf1-&1teLit L JAJ5_;A-LL 0� I� `.�'_ O/T & raVCL ►'i!� r'�� v�te�l
i
�Jl� 2-.5 WAL1L � 1-3'&v
r Second Electrical Meter
CONSTRUC1 1ON INFORMATION:
c b'ef-7Z�- .
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
—Mechanical —Gas Tank Gas Piping Shutters _ Windows/Doors
— Electric _ Plumbing _ Sprinklers Generator Roof
Pitch
Total Sq. Ft of CoII nstruction: Sq. Ft. of First Floor: _
Cost of Construcltion: $ Y, YCz 6 Utilities: ` Sewer Septic
QWNER/LES .EE
Name Itrz-i 'i 4,L�'
Address: _5-S6 9 /� IC K-612 Y A i 1V4
City: Pb.,-' ALf.c.L- State: `L
Zip Code: a? 282- Fax:
Phone No. '95 1 E-
Mail: (Srys ; i� izL►6c:s �rcc,�ac�rr
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Pond
CONTRACTOR:
Name:
Company: A 6'i4_c-kv7- i Lir�lYL ~
Address: '751 ,[_fQ LAc17Z7L1"k_1X4-` 61'r1 ,[ -
City: l viy— 51- LL'C�,L;- State: iL
Zip Code: 24 9.SL Fax: -7-72- y6m o2L7 2�
Phone No 77 Z Sit. 6Z7 3
E-Mail I.V i=0 c t? r 2ZrrtT ILL-x _z s�!
State or County License L G C. i'? 75 7 d
If value of constru tion 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.
SUPPLEM8NTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/'NGINEER: X Not Applicable
Name:
Address:
City: State:
Zip: I Phone
FEE SIMPLE ITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
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.
certify that no ork or installation has commenced prior to the issuance of a permit.
w Lucie c County akes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts lth 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 structt res, 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 Cou ty and posted the jobsite before the first inspection. If you intend to obtain financing, consult
with lenderor an tore} b re comm mcing work or recordingyour Notice of Commencement.
F T /. --' , /" /' I
Signature of Contra off- or Ow er B der aIS appiicable
i
STATE OF FL A i
COUNTY OF7�F- L0 '.
Sworn to (or aff rmed) and subscribed before me of Physical Presence or Online Notarization
this 23 day of !]4c� i°(pc�� 202i by
Name of person making statement.
Personally Knov n X OR Produced Identification
(�-Ignature�if Notary Publ c ��Frc Stateida)
Commission No. ��o. (Seal)
Notary Public State of Flonda
CgsW E Naylon
tits Enmrieft t3 GG 929549
ai Expiras 17706/20P.3
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
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