HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
917o LUC E RECE&pa
%W.70 °' y ``` Building Permit Application PQ °Fr s 1021
Planning and Development Services hnittinJ p
St' c,,, a ra
Building and Code Regulation Division Commercial Residential �!e r-0 ne
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 3 G
Property Tax ID #:
Site Plan Name:
Project Name:
S
�5 l D 1-Y
'TI:ON� i•
Bdo�®��`� Lot No.
Block No.
r t,.
:)TION` OF WORK m ,
�c dv1-/' /006 i A9 14L6 i>Ac:,k. 4r6 vmr)
New Electrical Meter Second Electrical Meter
(Affidavit required)
5
CONST•R'UCTION�'INFOft`MATIQN ,x'' ` � r � �' ' U' a `kt '` j
] tit �' l ,� � Pf 4 7 I i- . � �� �' ) ♦i Ct :' :S '� •t
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: $ V40V Utilities: —Sewer —Septic
Building Height:
G'OWNER/LESSEE ; ;n
CONkI RACTOR
Name Ct 0 r-r-
Name:
/
Address: ��� S �ll� �Yc� CJ"bI
City: �6 9)'Q4
Zip Code: N'Y'? Fax:
Phone No. S R 1 6 0
" cA (.
State: �L
E-
Company:
k S
�o
Address:
City:
Zip Code:
Phone No
i%94PO
State:
ax:
Mail: o2N�ASciC.'�2� rfAAil/N.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or Co
P� ,
my License
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 LIEEN LAW1 INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: go
_
Name:
Addressor
Address:
City: 4&> State:
City: State:
Zip: Phonet
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 conflicts with 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 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 County and posted on the jobsi before the first inspection. If you intend to obtain financing, consult
with lenderAr an attorney before" mmencing work or recording vour Notice of Commencement.
Signal ur of&nerAesseVhtr t r as Agent for Owner
STATE OF FLORIDA ]
COUNTY OF f�-�
`Physical
Swor to (or affirmed) and subscribed before me of Presence or Online Notarization
1
th is day of L�V • 20d by
0r V%-i
Name of person making statement.
J
Personally Known OR Produced Identification
Type of Id e ification Produced
(Signature of Notary Pub c- State of Florida)
`�ir�v rya�c;' AUDREY B. HUMPHREY
Commission No. (Seal) *; MYCOMMISSION#�GG300817
EXPIRES: March 6, ?_023 ,
Thru Notary PutrNc Undet�.vrilcrs J
Bonded
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Rev 52021