HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /-16 -Z02- Permit Number:
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
PERMIT APPLICATION FOR:
Z
PROPOSED IMPROVEMENT LOCATION:
Address: 68 cN- -BraR le Lir 80r� S L tA6e, R .3`1 c159-
Property Tax I #: 3 i l5 ° 705, 6 / c7 5° ODO+ 9 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
eD aee qQ PaAm e eG rl'a wa- e r
�;'(b Tor �J(e- —
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 Construction: Sq. Ft. of First Floor:
Cost of Construction: $ WM r Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name G E azc,-
Address 6B_ a 3i"0_ _r Cr _ _ _ _
Name: I^ IA/ Zane 16
Company: Fort LuCi 2 Plum b'nq
City: Port 5f Lc zel e State: rl-
Zip Code: -3q 5J- Fax:
Phone No. 77a $0� 5j �,6 E-
Address: D 1'Yi U e Dr
City: _Fort S1 LLLCIe State: 1 L
Zip Code: L25- - Fax:
Phone No 77d g68-65a q
E-Mail 1'� LIC;I U M I rl tia l • C'OM
T ^
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License I C. FC, Q 8L9 D a 5
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 conflicts with azy 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 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 nnust 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 lender or an attorney before commencing work or recording our Notice of Commencement_
Signa r f er/ Les 4/Contractor as Agent for Owner
STATE OF FLORIDA
51 L tkCl e,
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this /4�7 day of �;'A_ rZ ZQ Z_-) by
Gar . Qx nal la
Name of p rson making statement.
Personally Known S/ OR Produced identification
Type of Identification Produced
(Signature of Notary P*ic- State of Florida) um"M Dow
Comm.
U9Ud58
Commission No. 60 JU �3 (Seal) w?f"
25. 2W
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Pa %u Am � fy
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
KeV 5/ZU/Z1