HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZALIwi*nq 12 , 2-4 J_I- Permit Number:
g ra_ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4162-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Fly Ar c i ,u C�
PROPOSED JIMPROVEMENT LOCATION:
Address: j a
Property Tax ID
Site Plan Name
Project Name:
DETAILED ESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No. 4 3
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechani al _ 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: $ &_a a _31t3. rr.:a Utilities: — — Sewer Septic Building Height:
i
OWNER/LE
SEE:
CONTRACTOR:
Name SrLwe.�z
Address: --rY4-a
City: P&4vr rll
Zip Code: .3
Phone No. Ji'72.
Mail:
Fill in fee situp
from the Owner
": irr'r
Name:
►,s M10kry4v izorff�
Company: d
State: r_-
W 4.0 i Fax:
z iWi2 E-
Address: 7.5-/ .uuJ
City: i vim S iui Lz- State: AL
Zip Code: -74VR f- Fax: -1-7z qL,_�3 VZ7L_
Phone No '77 z OrI az2_3
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a Title Holder on next page (if different
listed above)
E-Mail ..ci=v �LL a
State or County License
it 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.
SUPPLEME TAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: & Not Applicable I MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State
Zip: , I Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip: —
Phone:
OWNER/CON RACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that now r rk 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 an YY 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 yo r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and p sted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an tt ne before mencin work or recordingour Notice of Commencement.
r - or Owner Bu er as applicable
Signature of Coitr
STATE OF FLORIDA
i
COUNTY OF
Sworn to (or affirmed)
and subscribed before me of S(- Physical Presence or Online Notarization
this =A. dayof.
.+44u��r 2o-Lzby
k `tc«i cr, I
l?l LEY
Name of perso
making statement.
Personally Known
OR Produced Identification
Ty ;of identification
r
Pro ed
'--4 10
(Signatl of Notary
Public- State of Flor'
Commission N
Notary public State of Flonda
eay0%
Crystal E Naylon
My Gomrnission GG 929549
Expires 11IDS12023
REVIEWS JFRO
NT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
OUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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