HomeMy WebLinkAboutBUILDING PERMIT APPLICATION JJ�
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Al APPLIC/jABLE INF0 MUST BE:C04VIPLUED.FORAPPLICATION'TO BE ACCEPTED
Permit`Number ISO
e�z �,w �urld�ng Permit Application
Planning and DevelopmentSerVtces
BLUWNn and Codeliegulation IVIsfon: Comme, rdaE, RESI_CI@tltlal.
2300 Virginia Avenue,Fort Pierce FL 14992
Phone:(772)462=1553 Fax.(772).4621sm CBOG'.Fund'ing _
ER APPL1CATt)N FOR:
Address. . Q .... D . . .
Property Tax ID#:
Site'Plan Names Block No, 7
Project Name:
_ 1
_ ,f�E«TatLED DESCRiF�T{"4N OF WORK _ � �r` ;`
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:� r�► 1?
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Kew.Electrical Meter, Second Electrical.Meter (Affidavif'required)
CONSTRUCTION INE(7RMATION-• � � ,;-�
Additional Work to:be performed under this permit check all that apply. I
+Mechanical _.Gas.Tank Gas Piping: _Shutters' ^Windows/Doors Road
ElecErc —Plumbing Sprinklers —Generator _Roof. Pitch
Total Scj.Ft of Construction:.. ._ Sq.R.of First,Floor
Cost:of Construction:$ ; .r±'a: Utilities; Sewer Septic: Buiidmg H.ghta
t?VtiYt�fER�LESSE ,
CONTRACTQFt <
4 Name 1 �ii� Name_ 6A2 !
Address: Q..I&dJ4 3mpany:• M .
Cit ' ,Ze�Ga State: - Addres P ae
Y .�
Zip Code•, .z�'�L Fax '�C�ty Yk�CL ���p ,� _... State:��..
Phone No:J772 / ��9/ E- Z'ip.CodesS- �, Fax.-.
.Phone No 1
mteTitle odronnpage•(ifdifferen Maii . ogrFitlinfee:si ►f t
from the Owner listed above) Slate or.County"Cicense.L'� SM
if va[µe:of.cons"ction is 2so0 or mere,aiRECORbED Notice of-00mencement is
lfvalue;of HAVCas$7 sbo.ormore,a REf.ORDED':Notice ofCommencementis:,require&
1
SUPP (ENTAL CC�N �RU Q�f I�EI�! t_AW!lVFORMAT10
DESfGIVEa[ENGINEER; �Noi'Applicable MORTGAGECOM#?Ah1X NotApplicabfe,
Name:, Name::
,Add ress:...... .- ...
Address;
_.
COY' Rate', Ci
.ty. Sta Zip: Phone Zip:
Phone:
FEE,SIMPLE TITLE 40L6ER: NotAppiicable BONDINGCOMPANY: lNot,_Applicabfe
N`arne.. Name:
Address;; Address:
City
_.. Phone: Zip: Phone_'
O1NI1 ml CONtMCtOR AFFID.VIT:Application is.hereby:made'to abtain.a Permit to do1he'work-and,insta#lation as"indicated.
1 certify that;no.work.or installattbtrhas'commenced'prior to the issuance of a permit,
St,Lucie County makes no:representation that is grantin a:permitwilFauthorizethe permit holderto build the subject:structure
Which conflicts with an Y appUcable,Hameowners Rssoaiaion rules,-bylaws or and,coveriants that may,restrict or prohibit such
structure.Please consult with,your'Homeowners.Association an3 review your.deed for any.restrictions which rhayapply;
incbris4deratfon of the granting bfthis-requested`permit,l do hereby agree that J Omit(,in all respects perform the-work
in accordancewith:the approved•plans;the Florida Building Codes and':St'Wcie GountyAinendrrients
The following building.permit applications are exempt from Ee
de'rgomg A`ful#.concurrency rev►ew:,room additions,
accessory-structures,swimming pools,fences,wails,signs,sen rooms.:and accessory uses to another nori-residential use:
WPeItI\IIRIG:1'O OWNER:Your fai#u Record a Not of Commencement may result,in(paying tuirice for
•improvement5toyourpr p Notice of mmencei ient:must:be recorded inthe,public:recorris ofist:
Lucie Ga my and pos bn e j bsite�befor h'e:first.inspection If you intend�ta obtain ff'nancingi,consult
With I er or an aft `rn a CbMth rici " w ork or recordy�ing your Notice of Commencement.
Stg ature ofOwner/.;1 see/Cunt ctor asAgentfor Owner
STATE OE FLORIDA
COUNTY OF-Lz .
t1
Sworn-to.(or affirmed and<subscribed;before me of ZPhysica1,Presence or Online Notarization.:
I thisd"ap of ZOhy
.
Name -y10 V (Jl S iQ r` G -. bt2: I✓I
N me of person making statement.
Personally Known. OR Produced Identification
TVpe of Identification-Produced G
(Signatures of Notary Pdblics-s o€Florida).
; ELIZABETH HOGAN
aWNoiuy Publio=State of FloridaComrditsionNb. ;(5eal) = commisaidr*GG 977877
Y CApti1.12,2024pires
REVIEWS FRONT ZONING: SCOERVISOR 1' PIJt#US `VEGETATION SEATUF2TI.1:. °MANGROVE,
CQUNTER E'REVIEW ' REVIEW REVIEI!{! i REVIEW R1=1%1£U17 REVIEW }
T
DATE
RECEIVED t
DATE .
l COMPLETEt)