HomeMy WebLinkAboutBUILDING PERMIT APPAV APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: of - o5 f .:Z.;2- Permit Number:
`C Cl�
C, 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
RVA
PERMIT APPLICATION FOR: /17 G/ o un o1
PROPOSED IMPROVEMENT LOCATION:
Address: / S0,4 R 60 R 6 41 qA
2 e ' 4/mZ -t fie'/'e FL
Property Tax ID #: J322- 507- Q 0A .0Qo' 7
Site Plan Name
Project Name:
DETAILED DESCRIPTION OF WORK:
1?5 ' 4 '' ,r _;�rl/ 8
New Electrical Meter Second Electrical Meter
(roves
Lot No.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping w Shutters
✓Electric ✓Plumbing _ Sprinklers
Total Sq. Ft of Construction: �/-? %. .3y
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ pOD Utilities: ewer _ Septic Building Height:
Windows/Doors _ Pond
Roof Pitch
OWNER/LESSEE:
CONTRACTOR:
Name'-)�k,61e�5` Me Ga�a� �%�
Narne:
Address: Dye
Company:
C-(V
City: G State:1"
Zip Code: Fax:
Phone No.�q/z• ffT
Address: _51r_
City:
/�
Zip Code: /
Phone No M yZ
Fax:
� 5
State: ��
y� 51ey
E-Mail: i'm� 9awan� Nl!5p/GF�• 4/9'
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Nat Applicable
!Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: +� Not Applicable
BONDING COMPANY: Aot 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 1 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, wails, 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.
Signat r f Ow er/ Lessee/Contractor as Agent for Owner
Signa re f C actor/License Holder
STATE FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Swot to (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
V Physical Presence or "Onlin�e Notarization
this IV day of r,�L�/�c_� L�r.. / 09/ by
Phygal Presence or Online Notarization
this r,Qday of 202A by
5V • C' �74G1/af'] %P.
Z ` �i `� �lG /l�%1%
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification IJ
Personally Known OR Produced Identification
Type of ident�iffl''cation
Produced N Sfa7�/�,�JCp�'���
Type of identification
Produced -
(Signatur of Nota[y Public -State of Florida
Of Flor;de
Commission No. (Seal)
01 .`'..°iQ 14�
�'- .._.. <
(Signatu of NgUTy,P,ublE� ,��ts� Flvr�da j tiri ��
I = 6' r ,Jr "Puol,c -'�ak3 of Rork :9
Commission Nr� LnllA.Mo)' -y IbSeal) �?
G. O h'i •'JfYiF71 SCkrl GG 2E 1•. (S
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.