HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE 1
Date: � �
NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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L L-r C-- dr-e,.
Permit Number:
Building Permit Application
Planning and Development ice
Building and Code Regulation Divi'S on
Vir gi n is A ven u e., Fo rt P fierce FL
Phone. (772) 4 -1SS Fax-. (772) 462-1S78
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address: 1 �qQ �7
Property Tax I D #40
Site Flom Name,,
1+401(.0 - 803-
Residential
�___L "')LAC�C�
Project Name: -- --
DETAILED DESCRIPTION OF WORK:
.�
New Electrical Meter
Second
CONSTRUCTION INFORMATION:
Lot No.
Block No.
I }
trica I Meter - — (Affidavit required)
Additional wort to be performed under this permit— check all that apply:
Z
Mechanical � Gas Tank _Gas Piping _Shutters
Electric
Plumbing
Total Sq. Ft of Construction:
I -
Cost of Constructiow.
OWNER/LESSEE:
Name V..- k' r ht +\,-%
Sprinklers
Generator
Windows/Doors
Sq. Ft. of First Floor.,
Utilities: Sewer Septic
Address; Ci L k_,ek__A
I .. State. �.
Zip Code: Nqc4r, FaXE -
Phona N o.
mail:
Fill in
fee
simple
Title Helder an next page cif different
from
the
owner
listed above)
E-
Roof
Building Height:
CONTRACTOR:
Name: t�fe�lsj0(l Cnc>5
Company:
ti
City -
Zip Cody: ')L'1CAC�G" _Fax:
Phone No "1, -I 2 - 2 P;h - S +-1C
E-Mai!
State or County License C.L-1 C, 1�
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 RDED Notice of Commencement is required.
4
Pitch
state.-F
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
Name:
BONDING COMPANY: X Not Applicable
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.
certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie County makes no representation that is bra nti rig a permitwill authorize the permit holder to build thsubject structure
which conflicts with an applicable Homeowners s ociatioo rules, bylaws or grid covenants that a restrict r prohibit such
structure. Please consu t with your Homeowners Association and review your deed for any restrictions wh ich may apply.
In consideration of the granting of this requested permit, I do hereby agree that I Mill, m all respects, perform the work
in accordance with the approved plans, the Florida Buflding Codes and St. Lucie County Amendments.
The following building permit applications arie
exempt from undergoing a
full
concurrent review: room
additions,
accessory structures,
swimming pools,
fences,
walls,
signs, screen rooms
and
accessory uses to another
non-residential
use
WAR N I NIG TO OWNER: Your failure to Record a Notice of Com mencement 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 an the Jobsite before the first inspection. If you intend to obtain financing, consult
with leffefer or an attorney before commencing work or recording your Notice of Commencement.
iafifu're of owner Lessee/Contractor a5 Agent for Owner
STATE OF FLORIQA
COUNTY OF I"b e},
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this I day of ���Qr�,���. , 20 _Uby
Name of person making statement
Personally Known OR Produced Identification
T fie, f Wen 'f icati n Prodded
(.5 i nature of Notary Public- State of H rich )
ommission No. � Ir
T
HH 055167
CPA,
OF r
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev�7ZD721
ENT
COUNTER
Expires Weber n, 2024
died Thru k6ftet Nary somes
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TITLE
REVIEW
MANGROVE
REVi EW