HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -3-1 r' as Permit Number:
771
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue Fort Pierce FL 34482
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: J
Address: 7 ZT Llf . II.S'_ `-b Trull cW / Fvr f cJ � Z uz2 e E� ..3V 9 5 o�
Property Tax ID #: 3`� a a' �� " �� ! � - 040o • ! Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
p a c e 30 cia lare e ec ri c
tl j -e - Dr Lr ki,
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
r
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
,Mechanical — Gas Tank —Gas Piping _ Shutters
Electric /Plumbing _ Sprinklers _ Generator
Windows/Doors Pond
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ j� / Dd a _ Utilities: —Sewer — Septic
Building Height:
OWNERAESSEE.
CONTRACTOR:
Name C/dr6 GtIvio I Wn M in
Name: OWY E Zanellb
Port S
Lurie ll
Address: c�. DtZ e--mef Company:
.
City: _ e s Wen Geri{4AV State:_
Address: 00erltciqer
Zip Code: Fax:
City: LiLcle
State: FL
Phone No. 7�,3 eJ ,�I ,7ift-i6CL E-
ZipCode:3495Z-
Fax:
Mail:
Phone No 77c2 Y68-&5c_� q
Fill in fee simple Vile Holder on next page (if different
E-Mail_D6 rf Ligie- p
I Lim 61 tla(a)- gt`14. C-OK
State or County License
C FC, d c� 5
from the Owner listed above)
It value of construction is zsuu 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:
DESIGNE
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: T Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Not Applicable
State:
Not Applicable
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 attornev before cornmencina work or recording your Notice of Commencement.
5ignat r f er/ Liss6eitontractor as Agent for Owner
STATE OF FLORIDA �
S!• L �c l e
COUNTY OF
Sworn to (or affirm�ed; and subscribed before me of
y Physical Presence or Online Notarization
this / � day of Jal-c 11 , 20 Z Z by
&ar v k/ Za n a Ila
Name of p rson making statement.
Personally Known V/ OR Produced Identification
Type of Identification Produced
J9=A - I
....
64
— —
(Signature of Notary P ic- State of Florida)
Comm.8038 S58
Commission No. GG3 D 09 (Seal) i�` -
E*w: Aug* 25, 2
4,��lJl
BMW% AM N*fy
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