HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2-1 I Z02?_ Permit Number:
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
Commercial
CBDG Funding
PERMIT APPLICATION FOR: YC,
PROPOSED IMPROVEMENT LOCATION:
__ -
Address:
Property
Residential X
Site Plan Name: (^'c�Ylnc)1 ` ;1 Block No.
Project Name: rwn e!' 1 \ � j
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: U--7
Cost of Construction: $Utilitie
OWNER/LESSEE:
Name i V kl' 1 j
Addres F�Qrw'n\ I A F4 V i I C.
City: K rfl-TState:
Zip Code: Fax:
Phone No. --I'-1 — 4C -- `--] 1�-�1 E-
Mail: I G32 X�eL1 `�I�l �'llll�,.('I�YVI
Fill in fee simple Title Holder or( next page (if different
from the Owner listed above)
_ Shutters — Windows/Doors Pond
_Generator Roof �T Pitch
Sq. Ft. of First Floor: (o—I j
s: —Sewer _ Septic Building Height: 2
CONTRACTOR:
Name: 5�
Company: j
Address: n
City:, -PI("V C d State:
Zip Code: 145 Fax:
Phone No __7 1J
E-Mail hin6,
State or County License C cc l �j 1
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable I MORTGAGE COMPANY•
Name: _
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
Address:
City:
Zip: Phone:
^1tA/IICf / f•Awre1 w wr....
`ulVot Applicable
Name: 7"
Address:
City: State:
Zip-. Phone:
BONDING COMPANY:
Name: _
Address:
City: —
Zip:
Phone:
Applicable
--i w %. i wn mrriuvi i : Hppncation is nereby 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 an attorney before commencing work or recording your Notice of Commencement.
f
L
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA� �, p�A
COUNTY OF '�'t�
Swor. (or affirme ) and subscribed before me of Physical Presence or Online Notarization
this ay of _120&2 by 4
Name of person making statement.
Personally Known OR Produced Identification
T� ooff,Identification r duced
A
KATHERINE HAVENS
Commission No. (Seal) MY COMMISSION#HH199309
EXPIRES: DEC 04, 2025
Bonded through 1st State Insurance
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW