HomeMy WebLinkAboutBuilding Permit Application AI I APPL lCAB LE IN FED M U ST BE CO M PLE f E 0 FO R APPLICATI ON TO BE ACCE PTED
Dates Permit Number-
.�� L ' CLl
a
W. I Building Permit Application
.Uud.drrg and a Regufarion Division Commercial Residential
2�00 Virginia Avenue, fort Pierce FL 34982
Phone= (772) 462-1551 Fax: (772) 462-1578 CBDG Funding —
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION':
Address- 2355 T RO VVBR I DG E= RD
Property Tax Il) #: 4-1 1-0015-000-4 Lut No.
Site Plan Name- PADRICK Block No.
Project Name; PADRICK GENERATOR
DETAILED DESCRIPTION OF OIL :
CL
New Electrical Meter Se-cond Electrical Meter (Affidavit required)
CONSTRUCTION I iFORMATION9
Additional work to be performed under this permit -- check all that apph{:
—Mechanical as Tank � Ga.5 Piping _ Shutters _ Wndow!�/Doors Pond
lectr- Plumbing _ Sprinklers enerator Roof Pitch
Total Sq9 Et of Ccnstruction, C) Sq- Ft- of First Floor:
Co-st of Construction: � Utilities: —Sewer _Septic Building height;
OWNER/LESSEE: CONTRACTOR!
Name F 0E.0 Name;
F -1 O ��
Address: �orr,pan�: � �
lit+{; Mate: Adres d.
Zip Lode; � � Fax: City- astiS State; L
Phone No 7 — E- Zip Code: Fags:
Mail Phony No -`
III in fee simpCe 7 #le Hal der on next page (i# different -Mail �k � ' '
front the Owner listed above) State or Co linty L i ce nse 1 31 C9171
1
If va lue of construction i s 2 SOD or m ore, a RECO RDED Notice of Com me-ncemerrt is "aired.
If value of HAVC is$7,501D or more, a RECORDED Notice of Cam mencernent i5 required.
U PPLEPA E TAL CON STIR U TION LI EN LAW 1 N FORMATION :
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY,. Not Applicable
Name; _ Name:
Address; --- -- Addrew —
City: _ State: City: State:
zip: Phone _ _ Zip: Phiiane: - -
FEE SIMPLE TITLE FiOWER: Not Applicable BONDING COMPANY: Not Applicable
Name; Name:
Address: Address: _
City; _ _ City- —�
zip: Phone: zip: Phone-
OWN EFL/ CONTRACTOR AFF I VYIIT App I i ca ti on is here by m ade to obtai n a permit to do th e wu rk a nd insta klatio n a s indicated_
certi fp th at no work or insla I lati on has cam menced pri or to th e i ss u ance of a pe rrn i z.
Si. I_u c ie County makes no representation that is ra ntin a permit will I I authorize the perm It holder Id e r to bu31d the s u djert structure
which cunfl i r-ts with an �ppI i ca ble Ho meown erg s( c_,.a io ri r u I es, bar I aws o r a n d coven ants that m ay restri et or prohibit such
structure_ P6ease consult with your Homeuwnem Association and review your deed for any restrictions which may apply+.
In considerakion of the granting of this requested permit, I do h erel y agree that I will, in a I I respects, perform the work
in a ccurda n ce with the a ppro,red pla n sr the Florida Bui Id i ng Cod es and St. Fu ci a Co u n ty A mendm ents.
The foII owl ng buiIding permit aRpIication5 are exernpt f rom undergoing a fufN corrcurrency re-view; room ;3.dd ilia ns,
accessory stractufes, swimming puaJS, fences, walls, signs, screen rooms and accessory uses to another non-residential use
A R N I NG TO OAF N E R; Ya ur fall u re to Rec*rd a N otice of CorrrrrtenCeMent m ay result in pa Yi ng twi ce fo r
lmprovements to your property{- A Notice of Commencement mast be recorded in the pull is records of St,
Luci.e 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 m-cording your Notice of Commencement.
Sign ature of Owner/ tesseelfo ntractor as Age-nt for Own e r
STATE OF FLORIDA
COUNTY OF
Sworn to j of off i r ed) and 5u lncri b ed before me of X Physical Presence or 0 n Gi ne Noto ri zati on �
this XN day+ of 2o2 by 1
Na me of p e rso n maki ng statement_
NoLark Pvthc S:xe o ricmriv
Personally Known OR Produced Identificatrun Bamala C Bagarnan
� 1 N' .GuhirhMIOM 226347
Type of Identi c�fion Produced, "+ L o.� E.xpi�ea06-10f 22
Sig natu re of Iota ry+ P u bite- State of Florida I
ammi ion Na_ IN�5ead� ;kti ;I ,,F� DEREK SCHUMACHER
olary Rub I I c-state of f wor I da
Comm I e sion a H}I 3642 6
16
SAY Com m issiov ExPire6
t, ! U U15,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVER
GATE
COMPLETED
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