HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
L V.Z., - J�;�!
V L c i E I) P. Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2.900 Virginia Avenue, Fart pierce 9L 34987
Phone. (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMITAPPLICATION FOR: 1�t?�
PRnpnSFD IMPROVEMENT LOCATION:
k-
L -'
Address: v2?LC'C7 r I f Y� • �.
Lot No.
_ � _
Property Tax ID #:
PVysq-sk.NeS�&V- I_tAS: Block No. �_---
Site Plan Name, I-I� d -
Project Name: \ Cc X, i
DETAILED DESCRIPTION OF WORK:
40 \PC
- L; Ye Y
Moau5C
New Electrical Meter %Aj A Second Electrical Meter^ (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
cost of Construction: $
OWNER/LESSEE:
Name�Ilft5tll
AAA-F—c
QfV-Slr
City. '
Zip Code: Fax: .
Phone No.- WAS
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof _ Pitch
Utilities: Sewer _Septic Building Height:
Mail:
Fill in fee simple Title Holder on next page (if different
CONTRACTOR:
Name:
_ Company:
Addre
�
+�L1�(L��� �n
,iC L
City.
State:
Fax: ��o�-$� I-CtOb9
i:- zip Code: � �
Phone Noa
li
E-Mail
State or County License 3
from the Owner listed above) �.
L--- RECORDED Notice of Commencement is required.
If value of construction is 2500 or more, a
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _)�_ Not Applicable
Name: _
Address:
City;
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City;
Zip: Phone: _
State:
Not Applicable
MORTGAGE COMPANY:
Name: _
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name; _
Address:
City;
Zip:.
Phone:
Not Applicable
ate:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as ind)cited.
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 buildthe 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
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 attornev before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA,
COUNTY OF_ 't -U
Sworn to (or affirmed and subscribed befoW me of Physical Presence or ______ Online Notarization
this 1 ^ day of , 20 2� by
Name of person making statement.
Personally Known �// OR Produced Identification
Type of identification Produced
(s
�iJ`'i 0 JULIE JANE MCCAUL 1
i Notary Public • State of WV
=. Commission d iHN 49824
OF
n My Comm. Expires Oct t, 2024
Bonded through National Notary Assn.
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