HomeMy WebLinkAbout14 Aqua Ra.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax. (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
1,
PROPOS
EED IMPROVEMENT LOCATION: J
Address: 7 AeuR !, a r se r? �G, C h FL .3 `� 9 5 7
Property Tax ID #: L1.6 ff 811 o UD o2 " o -30 -- q
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Reg rye 5i e an(e 5 owe-r- val ve i rt mQS er
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Lot No.
Block No.
h.
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 Roof _ _ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (t 706. Utilities: —Sewer —Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 6oberf LbnqName:
Address: 3 a a o M&SOni& V
City: SCt in -f C 1Cz 1 r S koG re 5 State:
Zip Code: Li8 D $a Fax:
Phone No. -7 7,7 c aWq - 1156 E-
r
Company: orS
Address: 0 eritaqe
e l b
Lurie u
Dr
City: Fort S LL.C(e State:
Zip Code: 349.5.2 Fax:
Phone No 7 7c2 q68 -& 5a q
E-Mail i# LW_aE Q I UM /1 t el co
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License I
C FZ a $ Do? 15
IT value oT construction is z!puu 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,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
DWNEK/ LONTRALTUR 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 an 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 1 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 commencina work or recordine vour Notice of Commencement
Signat r f er/ Les a/Contractor as Agent for Owner
STATE OF FLORIDA
S
COUNTY OF
Sworn to (or affirme ) and subscribed before me of
h
�/ Physical Presence or Online Notarization
this day of 1arc 20� by
rV kl,7aaale
Name of p rson making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Signature of Notary Pic- State of Florida)
Comml�",#",,G.G,,G�38068
Commission No.6024 W (seal) z
y�'''j► ttE
'�'.kled � 1�aw Notary
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