HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7- " &'l.2_ Permit Number:
§70 [ULU
\l';-,
V'ILE..0 R I
Planning and Development
Building and Code
El A Building Permit Application
Services
Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Win,d , • W CP hr-r_41 i
- ,
..) tr:' 0 • 4 '' (1 ''' ki ll ; L'''' 1:1 ' n'' 71 .2V I ' j ' ' ''' — .1 '4 .' ' ' r 1 74 .'(' 11. .
Address: 4 \\)k -,1-• . '1 \\1(.1. . ' Zr-Oth n-I
Property Tax ID #: 14St52• C.) \ ' bIl..0 b • OM • i Lot No.
Site Plan Name(n Block No.
(i l lProject Name: ' 14.-k-A ' irm. -0
1, , i
--
• F., • •
'
.e w i nd (fin)-), • --Le
New Electrical Meter Second Electrical Meter (Affidavit required)
k-,.....
..,..-t-$
• i..147H,z,- ;:„' ' - ' - • , ,,, , •,:di,n
L.iid
.. i
" .
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank Gas Piping Shutters indow Doors Pond ____ ____ — _
Electric Plumbing Sprinklers Generator Roof Pitch —— _ —
Total Sq. Ft of Construction: \U F-)ct Sq. Ft. of First Floor:
Cost of Construction: $ -1 40 I — Utilities: Sewer Septic Building Height:
i
,,,s-• , . -
Name Er tin i 0 iiin Name: t r(--lnii el --t-k' Iltrnon,
Add rectA -e -WIS 61‘4 Company: U1/4.AY16:11A) kAJ W 1-6/ '01,---(gerTheeli ft)
City: ym 6e4.a,.., State: "f-L--
..)
Address: e,E5-2._ cr-r-oe
Zip Code: 4U4 51 Fax: City:277Y Vali tCk-e) State:-F -1---
Phone No. 1 0 -",11,0 . 6 331 E- Zip Code. -2.4t3Z. Fax:
Mail: Phone No .40 ---)• —.e5q. 1.4bo
Fill in fee simple Title Holder on next page (if different E-Mail -...1---- V' inr 1 ; t,(Z LO.inC1014) (4)(506 ryiiinde
from the Owner listed above) State or County License Ce7 C15 )421. Lain
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.
DESIGNER/ENGINEER: Nc
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
MORTGAGE COMPANY: Not
Name:
Address:
City:
Zip:
BONDING COMPANY: 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.
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 attorney before commencing work or recording your Notice of Commencement.
_
Signature of Contractor - or - Own • Bui der as applicable
STATE OF FLORIpot
COUNTY OF v Lt:u CZAA4,1
Sworn to (or affirhagid) and subscribed before me of
this If) day , 20/Aby )0
dc.L
0:1;14.;„ KEELEY El-RENRUCH
•P,':-; Commission # GC' 951923
Epires February 23,2024
• , , Bonded Pau [my ra,n Inswence 800385-7019
Physical Presence or Online Notarization
Name of person making statement.
ersonally Known OR Produced Identification
on Produced
(Signature of Notary Public- St Florida)
Commission No.eols\co(Seal)
REVIEWS
DATE
RECEIVED
KEELEY EHRENREICH
Commission # GG 951923
Ei(pires February 23,2024
Bonded Thru Troy Fain insurance 800-185-7019
FRONT ZO ING UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER RE MG-REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETED
Rev /21