HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I SI ZZ Permit Number:
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OIL I�UCIIs `R.,
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° - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential L
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATIONEWW
Address: b,500 C-t . r P° e rc e FL 3H 951
Property Tax ID #: 13(o — 5 b) — — 00 — Lot No.
Site Plan Name: A9hitty G/ewn Block No.
Project Name: I
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 DL.Roof 3/I2- Pitch
Totatsq. Ft of Construction: Sq. Ft. of First Floor:
i
Cost of Construction: $ I51 50 D . bb Utilities: _ Sewer _ Septic Building Height:
OWNER/ LES CONTRACTOR:
Name e/1 Name: D kCP_ Lay'BO
Address: )ifAP,i Company: okca &Cgn 4 iG7
City: Y r State: FL Address: 3/yd SE Le/GQ 1 P/- G-6
zip Code: 32/ 9 5 / Fax: City: $4UG/4 State: _L
Phone No. 2 3 I — q&6 — O / E- Zip Code: 3-lcl9')- Fax:
Mail:laQIG�A� i3A%a� o'�•Cos�i Phone No ���3a`— 5
Fill in fee simple Title Holder on next page (if different E-Mail lrYh9i4 rnQAybo�fA�Pl�5✓tP
from the Owner listed above) State or County License CMG 133Z 3A/6
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.
SUPPLEMENTALCONSTRUCTION LiEN LAW INFORMATION:
DESIGNER/ENGINEER: —NotApplicable
IVORTGAGECOMPANY:—NotAppiicable
Name
ame•
s•
Address: _
City: State:
City: State:
rp: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not I[ ble
BONDING COMPANY: _NotApplicabie
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone
-Zip:_Phone:
OWNER/ CONTRACTOR AFFIDVIT: App]
i certify that no work or Installation has COMM
St Lucie County makes no re resentation that
which conflicts with ang applicable Homeowne
structure. Please consu t wit your Homeowne
is hereby made to obtain a permit to do the work and installation as indicated.
rior to the issuance of a permit.
any
In consideration of the granting of this requested permit, l 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 CountyAmendments.
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 attorn-iiibefore commencing work or recordinirvour Notices of Cnmmenrpmant
�Sfg<ciature,of-CatiS1aetor- or -Owner Builder as applicable
STATE OF FLOFDA
COUNTY OF Y Y1 Q J-tY1
Swom before
Presence
to (crafflrtpad) and subscribed me of
Physical or_ Online Notarization
this IQ day of fzbrtia �_ 201,)-by
Name of person making statement
Personally Known OR Produced Identification
Type of Plentification Producqd
(Signature of Notary ub - e orida)
6a-da•3U(
Commission No. (Seal)
THERESAJAFFE
Notary Public -State of Florida
s'a•. Commission k GG 202301
My Comm. Expires Apr 1, 2022
Bonded through National Notary Assn.
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