HomeMy WebLinkAboutPERMIT ISLE OF PINESAll APPLIIC�ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d\� 12-(:D2-2 Permit Number:
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
PERMIT APPLICATION FOR:-�('�pc-P�iGcC��,�„e�}
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j• 77 kR ,-PT�^H�,ald
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Property Tax ID #: Lot No._
Site Plan Name: Block No.
Project Name:
IN
DETAILED DESCRIPTION OF WORK:
rwclE1 ZSS-C) -
A-;!)1,1, 1Ci
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 0-Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �Q kpo'*LA-) Utilities: —Sewer —Septic Building Height:
Address: IOZ\C, -3S\,e C->-(-
City: State: F I1
Zip Code:n-AC't f914 Fax:
Phone No.l \--)' J61 S�
E-Mail: _
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:,a.,,k�I��'iiil��i��
Name:
Company
:"5�
Address:i"'�3
City: Stater
Zip Code: _1Aa Fax:
Phone No11
E-Mai I
State or County License
if value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable
of
MORTGAGE COMPANY: N Applicable
Name:
Name:
Address:
Address: State:
City:State:
Sta
City: _
Zip: Phone:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
— Not Applicable
ONDING COMPANY: _Not Applicable
Name:
Name:
Address:
I Address:
City:
Zip: Phone:
City:
Zip: Phone:
OWNER/ CONTRAC AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no w or In
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/ Lessee/Contractor as Agent for owner
STATE OF FLOR
COUNTY OF-c-�U�-
Stern to (or affirmed) and subscribed before me of
\Physical Presence or Online Notarization
this day of 29'16 by
Name of person making statement.
rsonall K t,
Type of Identification tp `4�^ Notary Public State of Fla da
Ashley Del Toro
Produced rssion HH 052369
Expires 10111n024
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER I REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIY!A t � CACOUNTY OF '�
Swoln to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this q day ofr*00u A)-kff by
Name of person making statement.
Personall Kn
Type of Identification 0 0-,Q# Notary Public State of Florida
Produced �: Ashle Del Toro
+y : c• y ommissm HH 052369
Expires 10/t10024
(Signature of Notary ublic- State of Florida )
Commission No. _ (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW' REVIEW I REVIEW REVIEW