HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 3 Date: ` 9 - Permit Number:
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ur I?_ C' U,, c L' L; 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) 452-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: /
Address: o?, 6 d 3_ I' dasPr al ozA lc-or7 /erCe FL _30 �k
PropertyTax lD#: _,..._... ....,_._.-'Lot No_
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
NeplaC& 30 ciailbn elecfrae i, at&r t�earfer art she, If
Li kc -Cor Like
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank —Gas Piping Shutters _ Windows/Doors _ Pond
Electric /Plumbing _ Sprinklers — Generator _ Hoof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ % 2 zyo,
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name e4 S U re R 5 ReCi1 Q 6.5 L- L_ el
Address: 1 0 O 1 X l P_ UWY S e 403
Name: Ary W7, an a 116
Company: Porgy' S LuCc 2 Plumbin
Address: Q r err cii~ r
City: Fo rf S State: FL
Zip Code. 349.5�- Fax:
Phone Na 77a Y6,6-65,;_�q
City: oc xk)a State:—
Zip Code: 3. 3 a- Fax:
Phone No. 7 7d 0,60- qo l 1 ("l 5 E-
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail�UC��
j i1C't e OM
State or County License I
_�,Q[`iLef.
C FC d a
from the .Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 3obsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recordinu vour Nntire of CnmmPnrPmPnt
Signat r f Werl Les a/Eontractor as Agent for Owner
STATE Of FLORIDA �
5. L
COUNTY OF
�
Sworn to (or affrmneO ) and subscribed before me of Physical Presence or Online Notarization
this day of / "1 ,�? iC h 20 4 ZZ by
Gir v k/Zaele
Name of p rson making statement.
Personally Known V/ OR Produced Identification
Type of Identification Produced
(Signature of Notary PII ►c- State of Florida) o '
r Comm.
+
Commission No. ti.Jb� �5 (Seal)
'
Rvu Aw 1*ry
fill
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
KeV D/LV/41