HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE, COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �••/•! Permit Number:
R ' Building Permit -Application
Planning and Development Services (�b(�l�✓���
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: c/ 1mpAG7 4v/1t1D0Gv,3 £ 2 1M10.AC7' s 6 D'5
Address: 200 L MAM? Z)k/t16 0 /oZ -B ✓EAJ-56 V ,564LIX/0 2';L N? %
Property Tax' ID #: 0002-000" 0 Lot No.
Site Plan Name: CLUB C000MY C0AJb0 , l Z)6-78 Block No.
Project Name: Afr /02-
/NSiAGL 3 im/-1ACT wi" olds £ 2 /N AWI_ c56 D
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing -
Total Sq. Ft of Construction:
Cost of Construction: $ R 220, 00
(Affidavit required)
_ Sprinklers _ Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
01NNEFt�L'ESSEE Ed
=CONTRACTOR
a
Name G 066kg r"LATA 0
Narrie
Address: Zoo 61, /WAZ D206 /02-13
Com. any:41&1 7) oe 165?�MAkS'�.
Address:
City: \la,500 6640 I State:
Zip Code: ,3��j�7 Fax:
Phone No. E-
City: aeff W4e State: 1L
Zip Code: .33y60 Fax: 510 '482 -7SOs
Phone No N91-533'8700
LP L/jre771 Fe0- eX1VZ5./UO%
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C 6 C 152,1012.
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE'COMPANY: Not -Applicable
Name: Name:
Address: i i;-in Address:
City: State: City: State:
P.hgne Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:, Phone:
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 an� applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 irispectidn. if you intend toobtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement..
Signature of Contractor - or - O e� er as applicable
STATE OF FLORIDA.
��Lrn
COUNTY OF
Sworn to (or affir ed) and subscr'bed before me of Physical Presence or Online• Notarization.
this Z day of 20�2 by
5'���
Name of person maki . sta ement.
P onall Kno n R roduced Identification
ype of dentifi a on}}Ptluc d
nature o Nota o • i�,,}tate o U&44kRRICK
:r • Not®ry Public State of Florida
Zm
missi� No. ;e�� q gl�Slon mm 127Il92
y Cbmm,,Expiret Aug 26, 2025
, ,,•
Bonded through National Notary Assn.
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