HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: EIVL
Building Permit Applicati®
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Planning and Development Services2 l
_
JAN 2
Building and Code Regulation Division Commercial Re.sildV;fltile Co
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:041
Address:_lZ� �U2t7Yl' � � � � �t�r llC ��,�o►� Ia�,,,,�� �L. ��9�f`]
Property
Site Plan Name: Block No._ 0
Project Name: 40�e_ « I;1IN
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New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit—check all that apply:.
_Mechanical _Gas Tank —Gas Piping' _Shutters _Windows/Doors , _Pond
Electric —Plumbing ,Sprinklers _Generator Roof Pitch
Tota!Sq. Ft of Construction: � .?")00 Sq. Ft- of First Floor:
Cost of Construction:$ 500 Utilities: _Sewer _Septic Building Height:
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aw
Name 5dulp SOAVCkdOC Name: R
Address: kk QCt -e 0_&k-Lr Company:
City: �Ovk �.S c,, state:�� Address:
Zip Code: L ,, pp Fax: City: State:
Phone No. 96 - J" 5 tif'—O 2 O Z— Zip Code: Fax:
E-Mail: G4AeUl _s 73 MOL C_6V -\ Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail _
from the Owner listed above) State or County License
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: P-L%)'( Z- _
Address: Address:'?o Boy,
City: State: City: it State
Zip: Phone Zip: :1!�2(f 1 Phone: '
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners 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 attorney before.commencing work or recording our Notice of Commencement.
signature of Owner/ see/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF
Sw99•T (or affir ed)and subscribed before me of _Physical Presence or Online Notarization
thi42 day of 2035�by
Name of person making statement. i
Personally Known OR Produ enti ation ✓/
Type of den ification Produced
(Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
Commission No. (Seal) •1;=0 "e4,State of Florida Notary Public
Corrimiss,ion # GG 207484
My Commission Expires
June 12, 2022
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DATE
RECEIVED
DATE
COMPLETED
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