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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BE COftBD FOR APPLICATION TO BE ACCEPTED --••���hh Date: /C`,C'� Permit Number: ,f.��ll ®� Building.Permit Application Planning ond'DevelopmentServkes Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(712)462-I578 PERMIT APPLICATION FOR: ,�� PROPOSED-IMPROVEMENT LOCATION: Address: 9�OOLt 3 �� Property Tax ID'#:, �9-��.�- r�Dy3 '©Oa ' 9 Lot No.—A�— Site Plan Name- Block No. !r - e Project Name: DETAILED•.DESCRIPTIONOF WORK: S00, ►�p� ,a- /�2u _fia l�D� y /�1�4 S New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: • • 4 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 Total-Sq.Ft of Construction: Sq.Ft of FrstTloor: Cost of Construction:$ 0'04. Utilities: _Sewer- ,_Septic Building Height: OWNER,/LESSEE: CONTRACTOR: a Name Name: Address: Company: City: �47 t � C5rs U •State:� Address:a6&'�9a V f) Zip Code:3JI Fax: City: State: drL Phone No. 2U $3e/- MG/0/D Zip Code: 61W Fax: E-Mail: Phone No(Z,) NgW-Dash Fill in fee simple Title Holder on next page(if different E-Mail b be n)u t ® Qua ' e•a�"'L 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. SU PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DES) NER�ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Nam Name-. Add ss: Address: City: State: City State: zip= Phone Zip: Phone: FEE S MPLE TITLE HOLDER: Pot Applicable BONDING COMPANY: Not Applicable Nam : Name• Addr Ss: Address: City: City: Zip: Phone:- Zip: Phone*, 01hlNE /MXTRACrOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. t certify t at no work or installation has commenced prior to the issuance of a permit St Lucie ount#yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is i cod Ict with any applicable Home Owners Assoctation rules,bylaws or and covenants that may restrict or prohibit such structur Please consult with your Home Owners Association7and review your deed for any restrictions which may apply. In consld ration of the granting of this requested permit,I do hereby agree that 1 will,in all respects,perform the work in accord nce with the approved plans,the Florida Building Codes and St Lucie County Amendments: The folio "ng 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 WARNI G TO OWNER:Your failure to Record a Notice of Commencement may,result in paying twice for imp ovements to your property.A Notice of Commencement must be recorded in the public records of St. Luci County and posted on the jobsite before the first inspection. if you intend to obtain financing,consult with a der or an attornev before commencen work or recordin . our Notice of Commencement. �P Signa 0 ecJ Less 1Cgntra Agent for Owner signatu f Co o arise o fier STATE F FLOR STATE OF FLO A COUN CIF Li t tag COUNTY OF Lt.r.C�/6 Sworn to or affirmed)and subscribed before me of swot to(or affirmed)and subscribed before me of .�fPhy cal Pies ce r Online Notarization Ph�y�ical Presence or Online Notarization this 2 ay of 20 2Z by this 2, day of�e .ZO z2 by Ear - A�Qf_h_s r Name of p sbn ma" tatement Name of p rson r tement. Personally Known_�OR Produced identification Personally Known OR Produced identification Type of id ntification Type of identification Produced Produced (Signature f Notary Pubnr,_ ate o �c��,,at a of Notary Publio-Sta n �Jyr►try Notary Public State o FI!>t1i ��V Pt4 otary Public State of Fbn a 1 O�{_ `h Bunnie Merritt Wood I'd `f Bunnie Merritt Woodard CommissIo No. t 0 GtIJa(� My Commission HH 3m1 on NO. o;�S��Ommisson NH 0398 Expires 09/07/2024 Expires 09/07/2024 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLEi'E ell: