HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
0 .
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: t Mt4m nrn
PROPOSED IMPROVEMENT LOCATION:
Address: `-)`6 It SDnn-e17r)V2 Toy+ fitYCf-1 FL- 3yq$2
PropertyTaxlD#: 341- U10- 0127,- DUD -$ Lot No.
Site Plan Name: Ay\4r% (Av� �C Block No.
nn
Project Name: l� -4,LA I I1A t I AiAA
DETAILED DESCRIPTION OF WORK:
4L) K I U ' C10 "(L.,
a
New Electrical Meter Second Electrical Meter (Affidavit required)
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: L 7 0 U Sq. Ft. of First Floor:
Cost of Construction: $ '�-I I r 3 t) Utilities: —Sewer ✓ Septic Building Height: 1 Z
OWNER/LESSEE:
CONTRACTOR:
Name Ah•COi
hl
lC JY
Name: Mi*01 I JUbk1601
Address:
Company: Cavy li fvt Coo adyA
City:foy 'PItiref, State:i�L
Zip Code: S9951- Fax:
Phone No. -1-I L - LpL?-) - 371 $-/ E-
Address: -lin (5GwainAl IrAc 'fvl,
City:N)bSuv1 State: IJ C•
Zip Code: 21 U I -1 Fax:
Phone No Sou- cl-w z
Mail:JYfAH IL 3041,I au 3ellscu a h• n tk
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Ju sik n • S &a c c i h0 • �i z-
State or County License C$G Its{gzZ
II4 Y= V• =V„'•'-,u--1 1- cove or more, a ntLunutu notice of commencement is required. II
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
UL5IGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:OK 1� hJ b lk Address:
City: ��--C6 , State: �� City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _vl Not Applicable BONDING COMPANY:
Name:
Name:
Address:
_
Address:
City:
City:
Zip: Phone:
Zip:
Phone:
✓Not Applicable
wvvgvcnr wry I raiaa.I UK ArrlUV I I: 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
ttorne before co
mmencin work or recordino our Notice of Commencement
itia J' /y
Signature of Contractor - or - Owner Builder as applicable
STATE OF F OMA
COUNTY OF Pf cn t yy
Sworn to (or affirmed) and subscribed before me of _Physical Presence or Online Notarization
this f 4' day of MArc4\ 20 "Ztby
Mi l:hai,( ;�-ohnsnr\
Name of person making statement.
Personally Known v/ OR Produced Identification
Type Identi'catio r uced
utri+
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(Sign t re o N GJ'da)
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Co m i ion Na EXPIRES G):
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Dee a. 2023 `
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