HomeMy WebLinkAboutPERMIT APPLICATION PALM DRAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2- \ZZS \2�2Z Permit Number:
.;ji v -,v
d. `i >_:° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Residential
Property Tax ID #: Lot No.
Site Plan Name:��� �� vQ Block No.
Project Name:
FDETAILED DESCRIPTION OF WORK:�II�I�°
New Electrical Meter Second Electrical Meter
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ci Utilities: _ Sewer _ Septic Building Height:
LESSEE:
Name` V, 0c-W-Y-l•-V
Address:
City: lv�- k P1 c_e State:
Zip Code-:-A1-A1 S Z Fax:
Phone No'1"12-- • -) C� � S Gj
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Cs 1�(-c' r =-->
Company1S2 c�y- Z\:>—[ '-JL
Address:
City: �)5 L- State:1P
Zip Code: ��-I�IsI� Fax:
Phone No: ,2 ' 1n
E-Mail 'C YG '0-
State or o ty Lic se -�)Q'Q Zy
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
5 K, .. n� Yam
':d.,.,:.. R R '•
ff� NotApplicable
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _
Name: Name:
Address: Addres
City: State. State:
Zip:
Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: t 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
whucture. Pleasle consult any applicable
Owners Associa on aO d rules,
ev ewyyour deed for any restrict that
which rmaor
aprohibit such
strIn 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 recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORA. STATE OF FLORID_
COUNTY OF �-t COUNTY OF �—�
9rn to (or affirmed) and subscribed before me of
�C Physical Presence or Online Notarization
this day of�G b✓��_g by
� , _ ��.. _ _ . ; 2�2 '1-
Name of person making statement.
fVpe—of Identification
Produced
(Signature of Notary
Commission No.
Notary Public State of Florida
Ashley Del Toro
tension HH 052369
Expires 10/11l2020
ic- State of Florida )
(Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
eve
Sw�arn to (or affirmed) and subscribed before me of
'C Physical Pre ence or Online Notarization
thi ZfS day of -'by
Name of person making statement.
Personally Kn _ n
ype o I entification +o`�' '0*, Ashle Del Toro of Florida
Produced 1.
y ommissm HH 052369
'� � �i«w�• Expires 10/11/2024
(Signature of Notary Public- State of Florida )
Commission No.
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW I REVIEW
(Seal)
SEATURTLE I MANGROVE
REVIEW REVIEW