HomeMy WebLinkAboutBUILDING PERMIT APPLICATION f
All APP INFO B ,LETED FOR APPLICATION'TO.BE ACCEPTED; i
Da 2� "�. Permit Number::. i I
,.
I
--
Bur ding Permit App �catioln
Planning and'Develapment-SeNfces m
Building anil Code Regulation Diyi sior Commerdal - Re$i&mial .
2JW Virginia Avenue,.Fort:FierceA 34982
Phone: (772)462-1553`Fax (772),462-1578
PERMIT APPLICATION, FQR: L
F
t,
PROPOSED IMPROVEMENT LOCATIC+N,
Address:: .0 1 f "( sofa
PropertV•Tax ID#: I.i{2. . `(%y `i' -JOc € Lot'No.
Site Plan Name:.—D Ce a t` Block No.
Project,Name:
DETAILED DESCRIPTION OF WORK •a
I i =
`C1. = go
ti .
New,Electrical Meter- Second Electrical Meter (Affidavit.reduited)
Fis7 CTI4IV Ifti4FOR11lIATlON f �`
k.TIRU
Additional workta be:perforrmed under this-permit—check all that apply::
echanical _.Gas'TanEt Gas Piping _Shutters —Windows/Doors _"Po►d:
Electric _Plumbing; Sprinklers _Generator _Roof Pitch
Total Sq. Ff,of Constructon:._ Sq.Ft..of First floor:
Cost of Construction. Utilities: _Sewer _Septic Building Height:
1
01NNER/LESSE `, CONTRACT{7R K
Name �a r t �2:t" Name (v1,U _
"Address: A) Y Com anY a,,,Vx ,
} C State;_PiL_; Address,.
City �
Zip Code: F;ax . City: lie+ i� ..State:
C ;
Zip Code: et C Fax- '} 7: ge z "3 C
- � Phone No. p: . . � •
E=Mail: Phone No,
Fill m fee simple Title Holder on nekt.page(.If,diffdre.nt; E-Mail At1 •Ica vet
i from-,,the Owner,listed:above) State or.County License
if value of con"structlon"is'2500 or"more,"a_RECORDED Notice of Commencement is required:,
if value of HAV. is$7,500-or more,.d RECORDED_Notice of Commencement is'required.
i
t
s
S( f? CEMENT LRICONS,TRI CTIO`N �I�N LAIN INFQRMAl ION
DESIGNER/ENGINEER=' ' 'Not Applicable MORTGAGE COMPANY:" of Applicable
h.
Name: Name:
Address: Address: .
City State City
Zip:. Phone` Zip Phone:
r
FEE SIMPLE TITLE..HOLDER:, of Applicable BONDING COMPANY: ot:Applicable
Name: l Name;
Address: Address:
City:, "City:. .
Zip: Phone: Zip .Phone:
i
OWNER/CONTRACTOR AFFIDVIT':;Application is;hereby made to-obtam a permitto do the work and installation as indicated.
I certify thatno work or installation'has commenced;prior'to the issuance of a permit.
St.Luce County"makes;no representation that is:granting:;.permit will authorize,the permit holder to buiid`the subject structure;.
which isan:eonflict-with-any", 'appticabte Home"Owners Associatio"n rules,,bylaws or`;ana coYenantsthat nlay`restrict,orprohibit such
structure.Please consult.vrith your Home'Owners Association and rev)ew'your-deed"for"any restrictions which mayapply.
In consideration of granting ofth►s requested permit,a"do.hereby agree that"1 will,mall respects,perform the work
in accordance with the'appmVed plans,the'Florida:B4'Ii*.g Codes and_St LUae County Amendments;
The i'ailowing bui'Iding permit applications:are exempt from undergoing;a full concurrency review;room additions,
y structures,swmmngpls,frte6S,"WlIsSgns,scree.n roolaaccgr uses to anOaCGBsso etd her non-residential use
WARNING TO OWNER:Your failureao Record a Notice,:of Commencement may resultin paying twice for
improvements to u, property,.A Notice..of Commencement must be:recorded in'the public records of St:
Lucie County n; ost on the.jobsite;before the first inspection: If you intend to obtain financing, consult
vv th:lerr r r. n atto n ' befo.re.sommencin "wor"k or'recordin our'Notice-of.Cammencement.. _".
Sig a. re o Owner/Lessee%Contractor as:Agent for Owner
STATE OF FLORIDA
Sworn to(or<affirimed);and subscribed,before me of �Pliysieal Presence<or Onlihe Notarization
this j tt4ayof_ Q i. 26 by.
Ck
i Name of person making statement.
{.. _ ..
is
Personally Known OR.Produced:ldent)f'ication.
Type:-of Identification.Produced
IL
;(Sign tyre f Notary Public-State of Florida):
vv�nni►n+
Commission No. f 7,tr, (Seal). ) 1FERGINADOIOR@SCR1SA�tfE -
4rY o; 11,419S16N N H113174
UXPIg5;WX25 202A:
REVIE111/5' FR(}NT ;ZONING SUPERVISOR' PLANS' VE6ETATIO.N SEAT.URTLE MANGROVE,
COUNTER. REVIEW REVIEW REVIEW, REVIEW 'REVIEW REVIEW
DATE
RECEIVED
DATE"
COMPLETED;:
Rev