HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I I I lwx?y Permit Number:
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t- c c EEL, fz Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: %"% W PbtDM(.<- c(lr1 Ve W V, erce, FL'�qq,.fy
Property Tax ID #: ooq 327 5W -004- 0(�ya1-
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
e�0 0-n ^ '��/(,tnU 2 !K� S r Y�/D.OZ�•�%i w,n:J�v► Si ✓LCn r •
i-.II.tfir� 1X4'0 IYrS v,,c/ nC li��� Jig, 4✓iCL,:.-. / �sL/ C�.:/n
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: _ 13 i.v
Cost of Construction: $ '�/30,
CO-
(Affidavit required)
Sq. Ft. of First Floor:
Lot No. 1/3
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: -Sewer _Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name buillit Q 77AQC4D
Name: keA- 1%
Address: hVrnCompany: jC'1L J2
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2eNYW r�1VC'
Address:/,C
City: fj7.Pl �ilr`e State:
Zip Code: 2>TJ Fax:
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Phone No.57e1 aD/ K% ] E-
City: !r - pi ✓rzZ State: FZ
Zip Code: _3g6k) Fax:
Phone No 72.. 3EjCtla(go
Mail:_ NC{VIG�/�(Ql%rt h n &-A Lc 42 G/rti;;/ ccyvl
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of rnnetn,rfinn it Icnn ..
E-Mail
State or County License l t
- -- ------. ...... v a.vunncua.on1apl rs requlrea. II
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
with lender or an attornev before commenrinp work nr rPrnrdina Vniir Nntira of rnmmanrcmnnt
Y/
Signature 6f Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO R.1Q A
COUNTY OF �Y (1tc, ,
Swo(or affir d) and subscribed before me of Physical Presence or Online Notarization
this rn o
day
of 20Z.Zby
Y,
r
Name of person making statement.
Personally Known _L__� OR Produced Identification
e of Identification Produced -"
(Signature of Notary Public- State of Florida)
Commission No. 1O 9 (Seal)
Notary Public State of Florida
Deana Mirabella
My Commission
011 tiN 203870
Exp. $112/2023
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