HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: P 13jao� Permit Number:
L. Ll! cuL
Building Permit Application
Planning and Developt ent Services
Building and Code Reg IationDivision Commercial Residential
2300 Virginia Avenue, art Pierce FL 34981
Phone: (772) 462-15 3 Fax: (772) 462-1578 C1BDG Fundinng
PERMIT APPLICATION FOR:ae f h �jri e5
PROPOSED IMP 0VEMENT LOCATION:
Address:
?SL9 Ca, V c.le OA
PropertyTax ID #: 3 1Z- - 10 -CiOC7^ Lot No.
Site Plan Name: Block No.
Project Name: ev-m �l-
DETAILED DESC IPTION OF WORK:
WL6V,i-- 2 k6ke c,, Y h
a 11 new 3& 1, 1 a c.
��la
a Ois CLOo(ie I "n �Aoltz Gt,r 1�1nSEa11 new 00'(C.( \Ella. qOoIJ
t�S�� �Wo }�AU'¢(�✓1✓v�Ct•rPt�JS odLXS
New Electrical Meter Second Electrical Meter (Affidavit required)
IMPSTRUCTION1
INFORMATI
performed under this permit - check all that apply:
Additional work to be
_Mechanical
_ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_Electric
_Plumbing _Sprinklers _Generator ✓oof Pitch
Total Sq. Ft of Constr
lion: 1�1&0 Sq. Ft. of First Floor: AJLO+
Cost of Construction:
I . a 50 Utilities: _ Sewer _ Septic Building Height: 15
OWNER/LES
CONTRACTOR: WEEMEN
Name ken&
Address:
City:
Zip Code: �
&-.LA!�esName:
-J>U Ic e- rz�
Company:-T-6ic.t Q vk.S1 m51*W-YMdQ%t GdPlEi
le. L1 L State: V—L
� Fax: (A
Address: 3146 J C WaR I -CV St
City: State: Fl.
Phone No. 1 -
l g E-
Zip Code: 3'FQQ"7 Fax: Z �3-gas- 8U33
1. coyn
Mail:
Fill in fee simple Titlie
from the Owner listed
Phone No 77a- 5r?z�-9030
Holder on next page (if different
above)
E-Mail perm Ns CE) +he Wt 61 ✓bcrQ ex1eAs.'-o
State or County License CCc 135 a54G
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7, Toor more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
ONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: P
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Nam :
Ad ess:
Stfie:
one
Ci State:
Zi Phone:
FEE SIMPLE TITLE H
Name:
Address:
City:
Zip: P
DLDER: _ N Ap ica a
ONDI 8T PANY: _Not Applicable
ame:
Addr s:
City:
one:
Zip: Phone:
OWNER/ CONTRACT,
I certify that no work or it
St. Lucie County makes nit
which conflicts with any a
structure. Please consult
In consideration of the gr
in accordance with the at
The following building pe
accessory structures, swit
AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
Ration has commenced prior to the issuance of a permit.
resentatlon that is BrantinB a permit will authorize the permit holder to build the subject structure
:able Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
your Homeowners Association and review your deed for any restrictions which may apply.
1g of this requested permit, I do hereby agree that I will, in all respects, perform the work
red plans, the Florida Building Codes and St. Lucie County Amendments.
applications are exempt from undergoing a full concurrency review: room additions,
ig pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNE : 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_tbe jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an efore commencing work or recording Your Notice of Commencement.
li
Signature of Contractor L
or - Owner Builder as applicable
STATE OF FLORIDA
I
COUNTY OF MaV�M
-
Swor (or affirmad) a
d subscribed before me of .r
Physical Presence or _ Online Notarization
this day of_
✓ 20y4-by
1 Icy LG
r�
Name of person making
tatement.
Personally Known
Produced Identification
Type entificatio r duce
(Signature of NottJau
- SSt to of Florida)
Commission No. liv
� :11/ (Seal) i?' ^Fr,, TH
-Sa ce of
Notary Puhlic -State of Florida
Public
Commission a GG 202101
> ^,
uy Comm. Expires Apr 1, 2022
l arded through National Notary Assn.
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