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HomeMy WebLinkAboutBuilding permit applicationKl ArPPILICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Cr Lo L'�V:SL - e: , c L c r:> c & - 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: n Address: 9{o D, N4 ©lean,4ck � fibo � S4. L[Cal te. Property Tax I D #: ? 14 l cT S /10 0 IR % I ®d Q cf Lot No. �1_e n Site Plan Name: / oR/t WA=) 191 Block No. Ad Project Name: `'C DETAILED DESCRIPTION OF WORK: New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: (Affidavit required) IN Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing /_ Sprinklers _ Generator oof Total Sq. Ft of Construction: � ! G 7& Sq. Ft. of First Floor: _ Cost of Construction: $ as 4 Ll cV - tv Utilities: —Sewer _Septic _ Pond Building Height: Pitch OW N ERAESSEE: CONTRACTOR: Name e& blov Name: lvu A`n oq Company: k L C- Address: N/�. 01MA City: &+ SA 64-crc . ( State: Le Zip Code: Fax: Phone NoS-01- Y 9 - PY7A E- Address: I/6l? S-w. //?atAe1/'11 `/ City-)00,a-s� z U c.a'`C State: oorl Zip Code: /3 q ,;-_5�-3 Fax: -, /®--� Phone No (���� c�(a- Sl97 Mail: R / y &M bLM?' �0»�(/R-S1c.�c Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail Rav p2 f nr S � 9 i' State or County License ��C ��313a if value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: Name: _ Address: City: — Zip: GINEER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable Phone State: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: Name: _ Address: City: _ Zip: Phone: BONDING COMPANY: Name: Address: City: Zip: Phone: State: _Not Applicable 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 improvem is to your property. A Notice of Commencement must be recorded in the public records of St. Lucie Co t and poste on the jobsite before the first inspection. If you intend to obtain financing, consult with le er ran attor ey before commencing work or recording your Notice of Commencement. Signature of C mra r - Owner Builder as applicable STATE OF FLORID COUNTY OF Sworn tp (or affirmed),an subscribed before me of Physical Presence or Online Notarization this day of f 20 by ent. Name of person makin:70R Personally Known Produced Identification Type of Identification Produced (Signature of Notary Public- S ate of Florida) Commission No. (Seal) �.►Xy Notary Public State of Florida JP04%�' Andrew G Reidy My commission GG 347651 Expires O6123f2023 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10712121