HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAli
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
C12)
Date: ZO 2OZ�_ Permit Number: O
;.� p 9--• ; �=r...` Building Permit Application
/
iPlanning and Development Se ' ices /
��((
;) Building and Code Regulation Division Commercial Residential
j 2300 Virginia Avenue, -Fort Pierce FL 34982
Phone: (772) 462-1553 Fax:';(772) 462-1578
PERMIT APPLICATION FOR: S F • PL
\, Il t
'Address: IN
;Property Tax ID #: ��1�` '-1 ��- lJ®®J �U - Lot No.
.,
(Site Plan Name: Block No. I
'Project Name: na I and �yyle
—
In
�,
s�Wll
-.aye. -m?i.'Yv_ -
Ne 7- car anyone.
New Electrical Meter Second Electrical Meter (Affidavit required)
= =_
_ P WE- �K
IN
I -
Additional work to be performed under this permit - check all that apply: =..;,.
Windows` Doors Pond
_ Gas Piping _ Shuers X / ,
_Mechanical _ Gas Tank tt
4 Electric Plumbing _ Sprinklers _ Generator Y,__ Roof Pitch
Total Sq. Ft of Construction: �`11 J • Sq. Ft. of First Floor: �1.��• � D
� a
i
Cost of Construction: $ 'Jyyl ®® Utilities: —Sewer K, Septic Building Height:
Vic'•- _ 2t�i_-$ IL � �r^��'}y'_,�-.r ��c.-tv �'Sa�r�.4. _
_ �_ _
_ -- __.
Name J_Q0WJGa0Y&LW_
Name:
Address: y1020 ( •Pmll ywk,
Company:
City: voyl �� I State:
Address:
`
City: State:
,��CQ
Zip Code: I_Ags� Fax:
Phone No.'1_11-W)(- i'�!
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
tate or County License
from the Owner listed above) Ne)I C�h
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.
f ;
I in
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not 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 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(ap attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF—
Sworn to (or affirmed nd subscribed before -me of :�<hyical Presence or Online Notarization
this day of yin 20q-
Name of person making statement.
Personally Known OR Produced Identificatiori
Type of Identification Produced '
�U
(Signature of Notary Publ" i
ELLEN V otary public
Commi ioRP,B f Florida#
o misso ExP�res
Com
'�� e My'CCo abt-
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
.'VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21 5