HomeMy WebLinkAboutBuildingPermitApp-MarshallAll APPLICABLE INFO MU$T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 91 — A I — �P. Permit Number:
e I L L 6=_ Building Permit Application
Pianning and DeveloprnentServiCes
Building and Code Regulation Division Commercial Residential _
2300 Virginia Avenue, Fori Pierce FL 34352
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 'Re - oo
PROPOSED IMPROVEMENT- LOCATION`
Address: r7 ' r Y" 1\tC.i "e . eL
Property Tax ID##: — .0—cl
Site Plan Name:
Project Name:
F DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Attidavit required)
CONSTRUCTION INFORMATION: ��
Lot No.
Bloch: No. 25—
Additionaiworlctobeperfor:rred under this permit — checkahthatapply:
_tiiechanical _ Gas Tank —Gas Piping Shutters _ Windows/Doors Pond
F..lectric _ Pltimbing _ Sprinklers _ Generator 01Roof . Pitch
Total Sq. rt of Construction: 3'3j q Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name I
Name: 5 - ° ' —
.
Address:
Company: i RU ` Gnq
City: &r' ar' ��_ State: r, L
Zip Code: .,9!'i uw _Fax:
i Phone No. -,5u 1 r _-- E-
Address: J_iq SKf
City: ,; '! _ State:.
a_.- 1 �� Fax,
Zip Code: _,a_
Phone No!'F 2
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail '3i�TC C$I�1"1
State or County License,
t If value of tonstru Ction is 2500 or more, ra KtLVKUtU NO[ICe UT LVn7r[[esiiefiirio[ �s eyuiicu.
`F 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: State:
Zip: Phone
Name:
Address: _
City: State:
Zip: - - -- Phone:
FEE SIMPLE TITLE HOLDER. X Not Applicable BONDING COMPANY: Not Applicable
Name: Name: f:�
Address:Address: y A
City: City: e _
Zip: Phone: Zip: J)34 3 L_ Phone:ti,
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or instaliatlorr 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 anyy applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please censult 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 futl 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
..?rk I.,.. A.,r nr tk-rnrn --inv wnrlt nr rpt-mr- ing vmt lr NntirP of CnrY mPncPment.
sig+aatu of Contractor • or - Owner Builder as applicable
STATE OF FLOI�DA
�,���^
COUNTY OF_U'f r II Gi e,
SWOT to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of cl mnuwu 20_; 2Uy
r t(
Nt me of person making c atamant
Personally Known OR Produced identification
Type of Identification Produced
'0�e'6f
(Signature of Notary Public -State of Florida)
jI
�rI
CAROLIMEltAE SELLLRS
r� ` ISeal
Commission No. )
Mowry
wry Public • sute of PId di
COMMISlon E MM 111015
My Collim 590fils Apr 13,1029
ilandm thrau�h Mltlanel Meury' Asfn,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
----
GATE
—
CO M P LETE D
__,�sm
xev :LU/:1.21 L1