HomeMy WebLinkAboutBUILDING PERMIT APPLICATION �E�p.�.�....�..�
All APPLICABLE INFO,MUST Be FOR APPLICATION TO.BE ACCEPTED j
Date: ��� �;$ Permit Number: [ \�� ��
St Lucie County
°Building. Permit Application
Planning and Development Services Y
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: f110110m, co` _ 5t,`3
Property Ta # �+ _ - Lot No.�
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Site Plan Na e. 3 "N� `� / .>• Block No.
Project Nam : _ . Z6� '"-7®3 ��p 0 l
WNE= �.
New Electrical Meter Second Electrical Meter (Affidavit required)
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 Constructi-n: / Sq. Ft. of First Floor:
W Cost of Construction:$ 3 '096 Utilities: —Sewer Septic Building Height:
HIM
IN
COME M&W
~Name (�M G Name: O
Address: 7J ILL sUC -� ���f Company: l (—
City: ���2 h State: Address:
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Zip Code: Fax: City: [ `!- 'L � Stater
Phone No. '1' ��p �� Zip Code:. Fax:
E-Mail: Phone No 7Z---3 Z,3 —
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or_ unty License _C:_ 00 o
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.
'W NMI an
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
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 permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home 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 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 Count and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi ende r an attorney before commencing work or recording our Notice of Commencement.
igUNO
caner/Lessee/Contractor as Agent for.Owner
STLORIDA
CO
Swor o(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this _ day of :01✓7 ,20 Q9bq_
Name of person making statement.
Personally Known OR Produced Id tification -
Type of Identification Produced L—
LEN VAUGHN
YP i r
(Signatureo b9ratit@ EF # )270079
*= Commission
y Commission Expires
Commission "� FF�"A M e 'or 2 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 21