HomeMy WebLinkAboutimg027.pdfAll APPLICABLE INFO MuST BE COMPLETED FOR APPLICATION TO BE ACCEPTED_acae
`."`,j--i
D E @ B 8 B a -I--
Planning and Development Services
Building and Code Regulaticln Division
Permit Number:
Building Permit Application
Commercial / Residential
2300 Virginia Avenue, Fcirt Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PRO'POS'ED I MPROVEMEN T LOCATION:
:x#EIEggE£1:_£%J-_¢cne_±_____ __ _ _ _ _ LotNo._
Address:
Property Tax lD
Site plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CON TRU Tl N FREORMATION:
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank Gas piping
Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: S
Shutters Wi ndows/Doc rs Pond
Generato r Roof
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:cONTRAeroR:
Zip Code,
Phone No.
Fill in fee simple Title Holder on neat page (if different
from the Owner listed above)
Company:
AddrEss:
Zip Code:
Phone No
E-Mail
State or County License
lf value Of construction ls 2500 or more, a RECORDED Notice of Commencement ls reqLIIred.
If value of llAVC is $7,500 or more, a RECORDED Notice Of Commencement is required.
<,'`:'>-',"\'}...'`-X,,.`'-,=`#,-',1<4..,.:.,¢r.[,),i,-ll '.!*-. i`}.\ :ri(.+\` /," I; -)I ,` ,` ^ :i` : ;``>x`|`,. r.,\ ..`,,`:,-I, ,!i:vi,:I ,: -ife I *4 ,r= I , ,t .`.:jryH.A;i.I.` `_: `.I `:(=,;. ,. `: +.)..I I:-,:./ ` .. v.. :, vy.-,S. ..i: `t ::; :,. <= r=7tr: .`|.i.,rs'(.*.r F\ : `t:-,.1 v',-~ `i.,`-`.," N`'_`.t `.i,. ` \:i-r+Jiiv.`t a. Ii\ '^`j+:` '.`.``.A.I
v\`I,`,^'.i Jr:, ( ., .: ',,,' \;,;
i`ill # SI-r`:i.,,`),;;-``
-, ,,i)I,t.L,:.,^`_I,L,
i ,.A '.`, u, :\,I, b' ,t7,..i .I :`, `,, `--.-::` I,`,trr' A/,/.:,.,-.,,;;,T=--(-( `\\`t,`-;,;=; I.-•,-,\,,``),,,(,,,:.,,,.,,`(,,-*.:.,,;A,,\,-,.,,``,.,,
•`-I-(, ``'ty-'\',I,-`¢-. ,, .'J.i-.'S,'ZINFER:NotApplicabl;
DESIGNER/ENG MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Address: \ A
City: State:City: \\ state :
Zip: Phone \ .\zip: pho#:\\ \\ ,\\\ \ \\ \,L^'LEaEms:rpLETiTLEHOLDN\|Nappiicable
a:mNe?'NG C°MPANY\ N \HNo\Apphcable
Address: \ . I 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.
naofrfie|Pc;aeoE|e#a:tfao::t#:'[s:ir:a:n:t:I:g:iSt. Lucie Cou
which conflic
structure. Pl
¢ragtiaoferLn|ej:.%jJ'iaa*!ho°rr:Znedt!:vpeenramn.|tshtE'adteita°vE:i'tdrjEt:rules, bylaws or arid covenants that n]ay res.trict or
on and r.eview your deed for any restrictiohs which rna
ln 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
LWEEEEefnvot?sn:dREEbet.r#.oAbc#m#be.ekoo::fEtmweT,?i#E.%tfst%#fbyeoLejcn°t:dneddt:not5tea.Pnufpti.ingyourNoticeofCommence
c records of St.ancing,consultment.
`' :`.s`.\.` -.,.i `!i-i,j!-i.
Signature of CoVIractor -o# -Owner Builder as applicable
SEA;AUTNE£FOFFL?¥iA ` i i n ,'rfQ_y \, ' -
:hTsoas\:ar::fff,rff§Enfe#;:`: :g,ffimf t _ phys,ca, presence or on,,ne Notar,zat,on
Name of person making statement.
Personally Known R produced Identification
Type ofldentification rodu ed
-- - ;.-i.,.,`ii.
:;ORE#;`t=c#r%,:;O;g;mG£9:£JOANTHAVER
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
ev TU I \ i I L|