HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ oZ -/6 -; 2- Permit Number:
t L` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential Vz
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:{ / /
Address: 13 yff� b/ �Crbolif' icloe Blvd
Property Tax ID #: l ,J6 6 U ' Q� z g • �Qd • O
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
e ee o alare e ec rye R4
i ke- -Per z i'ke-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
e f-
(Affidavit required)
,3 q�90
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
—Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Pond
Electric ✓f Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 z ,�>d, Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 5& tCofte-
Name: r
Company: FOr� 5
Address: d el'1 taqe
r" 6
Luti e, Numb
Dr
Address: 6a 1&_ D r Y
City:.._ _ Irer"head State:/4!
Zip Code: //g0 / Fax:
C-
Phone No. 97�a7- 7,6 /V%V E-
Mail:
City: Fort f Lucie state: FG
Zip Code: 3415-Z Fax:
Phone No 77a Y68-65a q
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rf 24 1 G,Cie D
State or County License
I UM i f lei
C FCi
-. -a■uv - —1-5 u«wl, - uu err more, a nn-vKucu mcnice or wmmencement is required.
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
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: ,Not Applicable
Name: _
Address:
City:
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 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 commencine work or rernrdin€7 vni it Kintira of rnmrndne,,nm n ,+
Signat r f er/ Les-a/Contractor as Agent for Owner
STATE OF FLORIDA
S L�tcl
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
this / `r day of t 20a2a by
Physical Presence or Online Notarization
Gt n P I le
Name of arson making statement.
Personally Known y OR Produced Identification
Type of Identification Produced
(Signature of Notary P ia- State of Florida)
Comm. �GG3B S5$
Commission No. 603A Q 6*6 (Seal) _ •'F�
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