HomeMy WebLinkAboutBuildingPermitApp-HazelAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Dot` A,), - 2;), Permit Number:
'c L L- LLL
L' Building Permit Application
Planning and DeveOpment Services
9uilding and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 'fie- rpp f
PROPOSED IMPROVEMENT LOCATION:
Address: Ll SE Anhqua Lane, I Pov-4-5ain+ cif
Property Tax ID#: 3g1q - Sol - )--�0) - 000-cl Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter . -—(Affidavit required)
CONSTRUCTION INFORMATION:
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors Pond
Electric _Plumbing _5prinkle-rs
Total Sq. Ft of Construction: r�Ji�l Isr
=1z
Generator Roof! f Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ 1 �A 03�4 3 . Utilities: —Sewer `Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
as 0 051
Address: q SEE AnblLcLn
Company: Tyem e-
. I.&rl
City: Ar SOti�lr' Li�l(:i;'_ State:f�L �
Zip Code: 84q c5A Fax:
Phone No. !311 4 -512-3 E-
Address: J.14 SW-PodS-Al lllkil5e PUMIR
City: I:br'E -f, LLUu'e'
Zip Code: � Aq(aH
Phone NIo,
State: FIG
Fax:
r1
Mail: r0ber+k VACLZe (i+ gQLk P ED ° C0M
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
'�y
E-Mail(IuVI(,� fY1 ,
" ,'111f7 ,r C0M
State or County License
LC
If value of construction is Z500 or more, a KECVKDEl) notice Or commencement is require(.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. 11
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -- - - --
DESIGN@RfEPiGltdEfR,— — Not Applicable MORTGAGE COMPANY: — otApplitable
Name: _ --_ _ Name:
Address; __ __- —
-_ _ I Address: —
City: — State: I City: State: Zip:--. Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: i( Not Applicable BONDING COMPANY: Not Appllcabif -
Name: Name: �VISle4Y.�l�.lr�_. ova"—
Address: Address: P-q+ S*p, +
I City: -- city: N �(
Zip-. __. Phone: - _Zap: Lx W 3 ! Phone: LpQ3
OWNER/ CONTRACTOR AFFIOVIT: Application is hereby made to obtain a permit to do the work and installation as indicated,
i cert?fy that no work or installation hd5 commenced pi for to the issuance of a permit.
St. Lucie County males no representation that is ranting a permit will 8othori2e- the permit holder to build the subject structure
whirl, Con' tfict, with an applicable Homeovmers�ssociation rut es, bylaws or and covenants at thmay restrict or prohibit such
structure. Please consult with your Hor,eowne, s Association and review your deed for any restrictions which may apply.
In consideration of the 8ranting of this requested permit, r 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 tollovnng b0cling permit applications air_ oxcm. pt from, undergoing a full concurrency review: room additions,
,accessory structures, swimming pools, tenres, walls, signs, screen rooms and accvssety 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 lendw;Aw, alattornev before commencine work or rernrdine unirr Nritict of Crmnrn nrPrnPnf
5irynatu r[a( Contra - ur - owner guilder as a�plica6fe
STATE OF FLORIDA
COUNTY OF-5 j
Spout to (or affirmed)and subscribed before mof Physical Presence or Online Notarization
e.
__.....- , 20�Z1,y
�..�ho N•coI s.
_A.A-_n.... r
Personally Known I OR Produced Idvnti€iration
--
Type of identification Produced___._ _,-
(Signature of Notary Pubiie State of Florida] fur, OUNE RAE SELi,7?M
1" ratAry PUYiic • Starr of Plvidia
Commission No. if ISealj Commission ► NW 117675
My Comm. Ex►srm Apr id, 2fl25
i - EtrCeE �s+rough btntionsl 4atiry Assn.
REVIEWS FRONT ZONING SUPERVISOR PLAINS VEGETATION SEATURTLE
MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
REVIEW
DATE�...—
RECEWFO
DATE
COMPLETED