HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S` , LLI CIL
C IK Y.:
11 0 L L E, - Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: KC-ROOF Of -&0I\Ae
PROPOSED IMPROVEMENT LOCATION:
Address: 5207 C l TRU S AVENUE I f7ow--r P►ev-c6, Fi, 3`-16 Z G
Property Tax ID#: 3`f0`�'Sa1 ' 07 7_0-l0o-0 Lot No. �J
Site Plan Name: Block No.
Project Name: _! k3 V C_iJ 4el?_
DETAILED DESCRIPTION OF WORK:
9E-gow ltbME rRoM qh J4—W TO 2(v A-A 5V META& W/ 2-
AT-0 C &c-eze SoMz- FAN S
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 _Pond
_Electric _Plumbing _Sprinklers _Generator VIRoof Pitch
Total Sq. Ft of Constructi(ojn::� 51 LL 5q -;-F-r Sq. Ft. of First Floor: 3121 1
Cost of Construction: $ 1 IJ ��WJ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameF7ARRtRA- 15r-*WCN kER- Name:-D"w" R-Y"-MtW
Address: 524C)7 GT"5 JJY&WC— company: AU 1AWCE 6i1L F
City:FoeT PIw'E State:rLL Add ress:6/5 NIN CVTf9M5fc AeI Pf--
Zip Code:3tf962, Fax: City:TO"St LaUE Stater
Phone No. 7]Z- iu�p6-IW E- Zip Code: 3�1�Fax:
Mail:QYl►15115c,h1 INr7H "M Phone No �Z'ff9
Fill in fee simple Title Ho der on next page (if different E-Mail ( •GOdo
from the Owner listed above) State or County License CCG
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.
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 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 aWattorney bipfore commencing work or recording our Notice of Commencement.
Signatur fCo tr 71tor-or-Owner Builder as applicable
CO OFORIDAGT W U � /
SworAA to(or affirmed and subscribed
scribed before me of `' Physical Presence or_Online Notarization
this'M day o�,201-Uy
Name of person making statement.
Personally Known OR Produced Identification
Tye Identific tion P duced
(Signatur f Notary Public-Sfate of Florida)
Commission No. 11q ELIZABETH A.SCILER
D`(Seal) * Notary Public,State Of Florida
Commission No.HH74732
Commission Expires:12/22/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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RECEIVED
DATE
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