HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �f:� Permit Number:y� �O
RECEIVED
91T. ILUC(140E .
FEB
° - Building Permit Application %J..�rei ouri n
Planning and Development Services
Building and Code Regulation Division Commercial Residential C f?-'-Jd
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: � ,
q Va n 14 uQ- coActo rh• nt%-t- A55oc.I w �z..L-AC,
PROPOSED IMPROVEMENT LOCATION, -
Address: 'Q'7co 110H w A( A F4- P. cnzL 3 4 41 CA 93
Property Tax ID #: l-4a - 7 V k/' Q 0 d 'C? ® Lot No.
Site Plan Name: !7q Vtin, ve- o Block No.
Project Name: A UC..A.' sve, l,P�cJca
DETAILED DESCRIPTION pOF WORK:
I e-a r 0 & \ CX '—CXi�. U'e_' l 1v � LCm c.-ee L 1�
i` 2J_ 5of Mco A., rA`S �i
:10 ?iv�_"Jft-�'& rot>f- /AJ ie )Gi�i 77 �j-
New Electrical Meter Second Electrical Meter (Affidavit uired)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
1
Electric _ Plumbing _ Sprinklers _ Generator V� /`( Roof cW f• Pitch
Total Sq. Ft of Construction: j 5��� S� Sq. Ft. of First Floor: A) I^
Cost of Construction: $ 3 �o�� yip. DO Utilities: _ Sewer _ Septic Building Height: �Oei
OWNERAESSEE:
CONTRACTOR:
Name • vCa^' . -e, o s 4, y G
Name:
1e-+
�
Address: -203 /i). H
Company:
Pr"• VAS "e. �
City: 1demL State:
Address:
QCbC S ISS7
Zip Code: _'3yq�Ct Fax:
City: }��
p
L"J�&cOG
State:
Phone No. q01- J (; S- N 08 E-
Zip Code:
Fax:
Mail: Us!S ' dvonom c+, c ota
Phone No
9 S'4- 733- 76(V&
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State r County License c c. 13
S 3 r3
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. a J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:_5fe,_JW1ck
_
Name:
Address: S1 19o•- hCJ--t, 6
Val. cU X.
Address: -
City: NuYfh wlv. &uJ,
State: t-V
City: State:
Zip: .33c-(O-6 Phone SG I-
8`/LI - it X(o
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
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 commencing work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF 761()WCVf
Swor before
Y Physical Presence Online Notarization
p(or affir ed) and subscribed me
of
or
thiisA day of Y :.r 20SL9 by
1`°1C19�1` & yC1q
V"�!'
Name of person making
statement.
Personally K OR Produced Identification
T p of I ntific t!on Produced
( ignature of Notary Public- State of Florida)
N�� (Seal)
KM
NESIS NICOLE CUBASCommission
Public - State of Floridamission a GG 261480m.
Expires Sep 23, 2022gh
National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1611L/Ll