HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
4N
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: 71502—Lo-I ,P ode, way ReUtl ,PL -_1�4q51
Property Tax ID #: J';O I 02,-> O(may q — b l ®— q Lot No.. 2-
Site Plan Name: Block No.
Project Name: �t Onn-t T 1;fMrn ()05
DETAILED DESCRIPTION OF WORK:
TE n I Gi lrD O-F Onct ► n -W l 1 i12 W Q' 50 1 t 5ht
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
_ Electric _ Plumbing _ Sprinklers _ Generator __JL�Roof
Total Sq. Ft of Construction: ; i Sq. Ft. of First Floor:
C t fC 11
os o onstruMon. $ I t�ilZ9 - c7Z� Utilities: _ Sewer _ Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name"rIC7 (� T= 6ji�MD
Name:
Address: —15b2 Wj41?ftGL9 W
Company; &6n
rU.Slo ion
City: 0 Mu State: L-
Zip Code: ��%q�j J Fax:
Phone No. �'�`��, q4() — W473 E-
Address: I
fsiL°-
Cit Y�5anfwj State:
Zip Code: �)2712 Fax:
Phone No( 1) d-J'(�a — q: f
Mail: 6irnr ZOOS J?jJQ_\iafio D -- cW
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail I IMOral'le M*ir)
- V,65tDrCr oD . Corn
State or County License ( f520Le
1
-u- -• ..—. ." W1I a uvv vi ruvic, d nc%,vnucu ivviice Oi LOmmencement 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: v Not Applicable MORTGAGE COMPANY: Not Applicable
_
Name: Name:
Address: Address:
City: State: City:
Zip: Phone State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 consu t 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 our Notice of Commencement.
tor - or - Owner Builder as applicable
PUNTYOF
A
n no\
/
Sworn to (or affir ed)and subscribed before me of V Physical Presence or Online Notarization
this ]:3 day "
W 20X by
^^of
LW
Name of person making statement.
Personally Known ✓ OR Produced Identification
T dentif' ion Produced
(Signature of Notary Public- State of Florida)
Notary Public State of Flog
Commission No. M3 (Seal) ®
Paola N i.am Melia,
. My coy:,, 1
t IfEI HH 7GoiiO3
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