HomeMy WebLinkAboutHood - Permit ApplicationAll APPLICABLEi INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: la��ja� Permit Number:
—T
S�,V. LLULL
U Building Permit Application
Planning and Development Services
Residential
Building and Code Regulation Division commercial-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: �AoO8\ , �itxSS2�
PROPOSED IMPROVEMENT LOCATION:
Address: 4RXA� �'0�h ^�1 � C6Soo C")J,
6 Lot No.
Property Tax ID #: 1� 1�
o� �p a - - � _
��
�
Site Plan Name: �c'C�ce�s fl�e+noi O D `,� \'I e Block No.
Project Name:
[D��ETA::IL:E:D:DESCRIPTION OF WORK: `' \
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
Windows/Doors Pond
_Mechanical _ Gas Tank —Gas Piping _ Shutters Roof —
Pitch
_Electric _Plumbing _Sprinklers _ Generator —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I i $�� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
Name r`C
Address:
City: �4\a'tc,�n'.c�S� Z�\or�c� State: �t—
Zip Code: OL194�1 Fax:
Phone No. ��> ��a� `13 �3 E-
M a i I : ��-`d�� 33@ c���ra �\ • C� in
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Y—',CY, 1\k c
Company: Nbta(1 xk2C1oK5�'�t��S S��v�5,_1S
Address: 51 l�K� 1r,Ini�-` �d'
State:
City:
Zip Code: 33Lt-e3 Fax:
UI: � -:r—Y-A . ' T D a
Phone No�55�t) LI�U --
l0p
E-Mail W{ nC'\ "\ C);R -,(- cc"> bIhLw.'hs=� of5lnC.e_
State or County License QL!33, 1 P-
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 MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
FEE SIMPLE TITLE H
Name:
Address:
City:
Zip: P
ne
State:
R: Not Applicable
Name:
Address:
City: —.
Zip: hone
BONDING COMP NY:
Name:
Address:
City:
Zip; Phone:
_Not Applicable
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
__�....,.,..,r.d n" "ni it Nntira of Commencement.
with lender or an attorney before commencing wui K 0i I EN-01 U11 - - --
"X' "
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Rc'-y ) R)Q•a-C�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 28' day of 1>CX-0-sv-Ar 20 X\ by
Name of person making statement.
11 OR Produced Identification
Personally Known
Type of IdentifWcatioypt-Pre
(Signat
v P� •.• LILIAN M ORELLANA
r° • ;fin: Notary Public Stat�$�ff Flan a
Commi €g «<. u 1'S'4
My Comm. Expires Oct 15, 2025
Bonded through Nationa! Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEATURTLE
REVIEW REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/11./11