HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3116 ILL Permit Number:
5�, 7 LuG ..uR
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Building Permit Application
Planning and Development Services
Building 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:
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Address: `1703 WINtEZ 6A2v PewY FT �IF@CCS of FL 3�95/
PropertyTaxlD#: 1301 (®®S QZ19* 0005 Lot No. is*
Site Plan Name: Block No. qff
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Project Name: AQ WE A411A E2
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit— check all that apply:
_Mechanical
X
Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ ?230C9V Al
_Gas Piping
_Sprinklers
_Shutters
_Windows/Doors _Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
TC
WOUTTWA
YIAIWL462
Name 1LXAE A
Name: AKCTY GUI V E6
Company: CDH PLC= rE EC4� 1 C
Address: 770.3 0gor(,e Ghto&r) flcwy
City: f*CT ?I FACE State: r L
Address:
(Ao3% SEoWafI AI*� BL V D
City: 6E11304T/At% State:rc
Zip Code: bg961 Fax:
Phone No. 1772. WO ®Z* E-
Zip Code: 752-U r Fax: 772 01 Z'-lii
Phone No 177Z 3tt ®533
Mail: NOL16' S93@ llbtAIAIL .Coto(
Fill in fee simple Title Holder on next page (if different
E-Mail MIO&A_EAU
from the Owner listed above)
State or County License EC.. ®O®1Q II
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.
1P4(�llicCA� f3Nft[CNLT
14
DESIGNER/ENGINEER.
Not
Applicable
_
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip:
Phone
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 attorney before commencing work or recording vour Notice of Commencement.
Signature Contractor - or - Owner s applicable
STATE OF FLORIDA
COUNTYOF 1► OIA10 RIVER „,,//
Sworn to (or affirmed) and subscribed before me of t( Physical Presence or Online Notarization
this,_Tdayof Iyhemeit 20_Uby
G
Re's?1 6UIDQ02.
Name of person making statement.
Known O� OR Produced Identification
Type of
(Sign�tur�of NUfary PfGblic-State of Florida)
Commission No. (Seal) [c= Notary Pn L State of Florida
Megpan iselon
My Commisalon
1111 HH au
2O5420
Exp. 12r7l2025
REVIEWS
FRONT
ZONING
ISUPERVISOR
PLANS
VEGETATION
SEREV
MREVIEWVE
I
REVIEW
REVIEW
I EWLE
DATE
COMPLETED
11�}��]��C�,�(��]7� 7Xfl�J�_�i[�7►��]i�i���C�1�1
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-4624553
FAX 7724624578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
T0: St Lucie County
RE: 7703 01A)r6e 6 1ZAP61M ?9W Y
Permit #
Credit Card Users: 1.5% Surcharge added per transaction.
Payments
must be received
in this
department by
4:00 PM
for transaction to be
processed
that
day, if not it
will
be
processed
the
following
business day.
�_ VISA ' MASTERCARD
Credit Card Number y�5�{ ' li%7 $3clr% 37/�
Expiratign Date nfn/Z9 Zip Code SZ4S8`0
3 digit security code 0 qS"
Amount $ + 1.5% surcharge
Business Name:
Authorized Signa
Print Name: ('nQ�-�`T
Phone: (72) - ' 0533
Fax:
Comments:
SLCPDSD Revised 4/Ol/2010 EN