HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
RECEIVED
�o
JAN-0." ,. ikv BuildingPerrrait A licati
p p ®n St.Lucie n oun
Planning and Development Services Permitting ry
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:
go mgl - -
Address: /D CGYGLf
Property Tax ID#: �tU3- 5b2 -(�2co2 -0��2 Lot No.
Site Plan Name: Block No.
Project Name:
- _ r z
Nw-2-90 01 WIMINE
V.&SIyC'l..Q
New Electrical Meter Second Electrical Meter (Affidavit required)
Ell--I A�11 ON-
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 First Floor:
Cost of Construction: $ 5, 6o6 Utilities: —Sewer _Sept ic Building Height:
I�.�s�'�.�.�.�
Name kp e le_ ��rx l-.Vav\. Name:
Address: ID") COi "l - Company:
City: State: I_C, Address:
Zip Code: �`I�rGZ Fax: City: State:
Phone No. (-7-12) 323- -7752 Zip Code: Fax:
E-Mail: PI;4t2 . W 114"ak (2 Y&AuD-cck-1 Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail -
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 HA
VC is$7,500 or more, a RECORDED Notice of Commencement is required.
-0 WE ON
"'M
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 w
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 toffy
r property. A Notice of Commencement must be recorded in the public records of St.
Lucie Count anded on the jobsite before the first inspection. If you intend to obtain financing, consult
with lends or arnebefore commencin work or recordin our Notice of Commencement.
Sign re of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF cj�' LLu c�-2
Sworn to or affirmed) and subscribed before me of _Physical Presence or Online Notarization
this day of �]/�,� 20_11
Name of person making statement.
Personally Known OR Prod ced Identification
Type of Identification Produced
(Signature of Notary Pub c-5ate of Florida)
Commission No. (Seal)
" HEATHER BURFORD
4PRY P49 i
';.State of Florida-Notary Public
►5 Commission # GG 183217
my i
�nr�°� Fe rust s it s
REVIEWS FRONT ZONING SUP SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 1