HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t (1 ZZ-
Permit Number:
I, LuC- U Li
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:
PROPOSED IMPROVEMENT LOCATION:
Address: I 1 7-+5 M u llcv i%(
Property Tax ID #: 2 3 1j 3- Li 2 2- D O pQ -boo - S Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
� n S+eW n r,w -Ft c d +D 44y' Atm .
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:: V Cost of Construction: $ 5O .
Gas Piping
_ Sprinklers
Block No.
(Affidavit required)
_Shutters _ Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
A .YUNSC,
Name: M1&6,e,l
PncJr,
Address: 11261 Mu11nr V2a1
Company: Prig, EIfc-+Y-
Cx.l of--P�
City: Ft PiwLc. State: r L-
Zip Code: 3`1N11S Fax:
Phone No. E-
Address: e43 S yi,r,
s Itw�
City: Forfi Dir-c-e-
Zip Code: 34 A q 5
Phone No 1 -72 L+Lel
State:F-L
Fax:
2l 71
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rn 1 k-c j2 j?r
I Ic - elr.(,fri 0.11
State or County License
CG 1300585�1
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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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 Brantingg a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consuYt with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 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 roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and po d o the jobsite before the first inspection. If you intend to obtain financing, consult
with le orne b fore commencing work or recording our Notice of Commencement.
Sig t e of Contracto - Owner Builder as applicable
STATE OF FLORIQA WC�
COUNTY OF }-!r
Swor tp (or affirm! and subscribed before me of V Physical Presence or _ Online Notarization
this LiDday 20aby
Jp(a+�`*�VH
1A'off
J//�
Name of person making stat ment.
Personally Known V OR Produced Identification
Type ofl�entification P,toducedf-
(Signature of Notary Public- State of FI rida)
Commission No. (�`rlD5) (Seal) David Raymond Prue
NOTARY PUBLIC
STATE OF FLORIDA
V
CommN GG287052
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DATE
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Rev 16/12721