HomeMy WebLinkAbout Building Permit Application ,
All APPLICABgyq O:lJ§BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number: lUL
•
Building.Permit Application
Planning and DevelopmentServices /
Building and Code Regulation Division COl'1 merCial Residential A
2300 ilirginla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-IWB _
PERMIT APPLICATION FOR:
PROPOSED-IMPROVEMENT LOCATION:
Address: �"d ip MM", 2& X&
Property Tax 1D-#. Agtj s-d3-00/Q-0D0 -4 Lot No. 17
Site Plan Name: Stock No.
Project Name:
DETAILED=-DESCRIPTION-OF WORK:
v a0 P,51
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/Doors `Porid
Electric —Plumbing —Sprinklers _Generator Roof Pitch. _
Total-Sq.Ft of Construction: Aa0 Sq.Ft.of First'Floor:
Cost of Construction:$ /T 4?4D. Utilities: _Sewer- `Septic Building Height:
OWKIN" L -SSEE: CONTRACTOR?_
Name _ Name: a
Address: 9y08 C&_ _ • _ Company:
r
City: . SO ,ram ) -State: Address: lwo 9a v�/.J ,�2�1.
Zip Code:3$y 9.3/ Fax: City: tpez State:
Phone No-riz/ a27 //Qh Zip Code: Fax:
E-Mail: Phone No.(7m) sswa-eLSl7
Fill in fee simple Title Holder on next page(if different E-Mail h b C 0,a S t ® gie"? ► QLOWI
from the Owner listed above) State or County License CBL'
IF value of construction is 2500 or more,a.RECORDED rilotice of Commencement is required.
If value of HAVC is$7,50D or more,a RECORDED Notice of Commencement is required.
� f
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name _ Name:
A d d r I.,ss: # of Address:
City; �e State: 4 City: State:
Zip:.R32Q Zip: Phone:
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 installation as Indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Nome Owners Association rules,bylaws or and covenants that may restrict or 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 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codas and St Lucie County Amendments.
The4ollowi6g building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 financing,consult
with lend r or an attorney before commenting work or recoriding your Notice of Commencement.
Signature-es-see/Contractor as Agent for Owner Signature of
STATE OF FLORIDA STATE OF FLORID
COUNTYOFF� Z-ucc'�e COUNTYOF '� WC.c�
S to(or affirmed)and subscribed before me of swoAto(or affirmed)and subscribed before me of
,. ftysical Presence or Online Notarization C"physicaI Presence or Online Notarization
this day of�C&jWZ!20U by this ,day of C•P— i.. .Zfl 2!, by
` S
Name of pers'n maidnyWtement Name of person makin ment.
Personally Known/_OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Type of identification
Produced Produced
Signature of Notary Public-S MIffilature of Notary Public-
00 v Notary Public State of Flori a �fY r Notary Public State of Florida
Commission NJ AI). nee Merritt Woodard /� 9 �f g ,e erritt Woodard
4"40nommission HH 03982 Co ission No. ir7 O N0tission HH 039826
' Expires 0910712024 4? ' Expires 09t0712024
ar. orn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lieu.