HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE. COMPLETED FOR APPLICATION TO BE ACCEPTED
ermit Number: Id
Date: Permit
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
V/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: I o7o f S;c uT*J OC-F—PAJ Lo r 4-:?—
Property Tax ID #:
Lot No.
Site Plan Name:
Block No.
Project Name:
9=7 t® ® T _5_'K E OW 5_ P OPIL Q0 WIAIPe RIS
t rna rL s res, 4 a0' -mm-- ;0,o97n4& --,rAlYd, 384P
New Electrical Meter Second Electrical MeterN A (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 Construction: I= T- Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:, —Sewer, —Septic Building Height: ig
n Y L.,
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Name R14 LHO Al Y S'l 7Name:
_
Address: 7 0 1 15Z 0, 0 " a *J , L6—)4Z-3
Company:
City: F�.F /V It& 9AUQf State:
Address:
Zip Code:,? Y rtS:Z Fax:
City:
State:
Phone No. 1- 3 1 5-L— 7 2-0— 7 ?Z y E-
Zip Code: Fax:
Mail: eA 1 1, S_ ; 3 @' 6aoy r_J*gn_A2S_r
Phone No
E-Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worn d11u a�
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owrfef7 Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 1
COUNTY OF � cL �
Sworn to (or affirme and subscribed before me of Physical Presence or Online Notarization
this- day of 24D'I by
Name of person making%3tatement.
Personally Known ' OR Produced Identification N%4
Type of Identitation Produced IFL ��IAX� -
(Signature) rotary Public -State of Florida
Commission No. (Seal)
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
LAG-KWNAINGRAM•RAHMING
My COMMMSION 0 GG 275060
EXPIRES: December 20, 2022.
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SUPERVISO
REVIEW R I REV EW NS I VEGETATIEVIEWON I SEATURTREV EWLE MREVIEWVE