HomeMy WebLinkAboutBUILDING PERMIT APPLICATION PAGE 1All APPLICABLE INFO �UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( 11' Permit Number:
9`Lr. L-l=! C'UL
-' 0
Building Permit Application
Planning and Develop ntServices
Building and Code Reg ationDivision Commercial Residential
2300 Virginia Avenue, rt Pierce FL 34982
Phone: (772) 462-15 3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMP OVEMENT L
Address: }lg N w YYIa✓>+er alrn er
Property Tax ID #: f{ jS `0 3 ` 00 3>- wo - I Lot No.
Site Plan Name: 4 F741 44T Block No.
Project Name: 6f
DETAILED DESC IPTION OF WORK:
je t- rva i ruo
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRLICTIO INFORMATION:
Additional work to b performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_ Electric _ Plumbing _ Sprinklers _ Generator �oof Pitch
Total Sq. Ft of Constr ction: 00 Sq, Ft. of First Floor: &'0 0
Cost of Construction $ .15CU W1 Utilities: _ Sewer _ Septic Building Height: 10
OWNER/LESSEE
CONTRACTOR:
Name ' wCyIl
Name:_r__AJICC LA10-
Address: L22, %a MaIr'%ner- C,iz.
Company: 7iEal (lo Si�N 1 �oc7f
City: al rrr CA,4 State: C—L
Zip Code: N 4 Fax:
Phone No. 11 - I ft(�o— a0 E-
Address: 300 SE Waa f✓ Q7•
City: S�✓'k state: FG
Zip Code: 3.4gq^1 Fax: 1'1� 87i SN3'J
Mail:lv:�ksr ortrA04ll Caama' ( CAr"
Phone No 773 I'11 frO30
Fill in fee simple Title Holder on next page (if different
E-Mail rt>dP exMW Ate
State or county License CCC- 133 '--3*0
from the Owner listed above)
If value of constructi
If value of HAVC is $7
n is 2500 or more, a RECORDED Notice of Commencement is required.
Soo or more, a RECORDED Notice of Commencement is required.
PPLEMENTAL
ONSTR—uFn N LY . INFORMATIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
Ci : State:
Zi Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable
Name:
P Y: Not Applicable
BOVe:
NaAddress:
AdCity:
CitZip:
P
one:
ZipPho
e:
OWNER/ CONTRACTOR
AFFIDVIT: A
I certify that no work or ir
stallation has con
St. Lucie County makes nc
representation tl
which conflicts with any a
placable Homeov
structure. Please consult
rth your Homeov
In consideration of the gri
nting of this requ
in accordance with the ap
roved plans, the
1 is qa
de to btain a mit to do he work and installation as indicated.
prioruanc of a pe it.
tin will a thorizehe permit hot er to build the subject structure
ociagtion rules, byla s or and covenants tha may restrict or prohibit such
ociation and review our de d for any restr ions which may apply.
rmit, I do,hereby agr a that I will, in all respects, perform the work
uilding Codes and St Lucie County Amendments.
The following building pe It applications are exempt from undergoing &full concurrency review: room additions,
accessory structures, swiroming 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 Dosted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an 3ttornev before commencing work or recording our Notice of Commencement.
or - Owner Builder as applicable
Signature of Contractor
STATE OF FLO IDA
COUNTY OF
vY�
Sworn to (or affirmed) a
id subscribed before me of _ Physical Presence or _ Online Notarization
this _ day of
20_ by
Name of person making
statement.
Personally Known
OR Produced Identification
Type of Identification Pr
3duced
(Signature of Notary Pu
lic- State of Florida)
Commission No.
(Seal)
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