HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIIAPPLICABTE INFO MUST BE COMPLETED FOR APPTICATION TO BE ACCEPTED
Date: 3 -rLt -r1 permit Number:
51; tUCIIE -\t
@,,7i *-:-; Building Permit Application
Planning ond Development Seruices
Building and Code Regulation Division COmmefCial Residential X
23aa Virginia Avenue, Fort Pierce FL j4982
Phone: 1772146?-t553 Fax: (7721462-L578 CBDG Funding
Address: / / S 5 Her."',-.b Uc^e pSL F-t 3.t1Sa
Property Tax lD #: Lot No._
Site Plan Name: Block No.
Project Name: j-- f er,t, .r'er.vr-,r:L
l orrntio oriC
i'i -.rr- X
New Electrical Meter Second Electrical Meter (Affidavit required)
I CONSTRUCTION INFORMATION: Itl
Additional work to be performed under this permit - check all that apply:
@echanical -
Gas Tank
-
Gas Piping
-
Shutters
-
Windows/Doors
-
Pond
-Electric-Plumbing-5prinklerS-Generator-Roof-Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Constructio n: $ il i, r-'r- r-', ') Utilities:
-
Sewer
-
Septic Building Height:
OWNERILESSEE:CONTRACTOR:
City: fr,r-t St- ( .-,r,.(State: FL
Zip Code: .3./ 9Si fax:
Phoneruo. t {/:-- zcc.J{lc E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: JqS..r Cai p.kle-([
Company: ( tr "'' fr,,''t\ (tr,-
Address: 9* { atd P-Aaf re{=. C, rc k-
City:?atl S. Luc,e State: FL
Zip Code: 3-/'1& 3 fax
Phone No ") -1) ? A .'? is7o7
i,Y,i"
lf value of consffuction is 250O or more, a RECORDED Notice of Commencement is required.
lf value of HAVC is $7,5O0 or more, a RECORDED Notice of Commencement is required.
PERMIT APPLICATION FOR:
PROPOSED I M PROVEMENT LOCATION :
/1 S{ Hernn,rv{rs / ^t
r
DESIGNER/ENGINEER: @
Name:
Add
City
zip:
lress:
State:
Phone
MORTGAGE COMPANY: _\l,tot Applicable
Name:
Address:
City:State:
zip:Phone:
FEE SIMPLE TITLE HOLDER: Y NotApplicable
Name:
Address:
City:
zip:Phone:
BONDING COMPANY: \ZNot Applicable
Name:
Address
City:
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 Countv makes no representation that is Rrantins a Dermit will authorize the oermit holder to build the subiect structure
which conflicts with anv applicable Homeownerslssocia-tioh rules, bvlaws or and covenants that mav restrict or prbhibit such
structure. Please consult With your Homeowners Association and ieview your deed for any restrictions which may apply.
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
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. lf you intend to obtain financing, consult
with lender or an before com ing work or recordi Notice of Commencement.
of Contractor - or - Owner Builder as applicable
frarr oF FroRrDA <L hr&[ lrurLcouNw oF >r uuw u
7--T- -"-'-Swortrtq (or affirmed) and subsgribed before me of t/Physical Presence or _ Online Notarization
tnis Z{ aav or f71 /7-/Cl- , zofuy
Name of person makingjlglenerft.
/
Personally Known OR Produced ldentification
Type of
Cornmission
STATE OF FLORIDA
Comn* GG262780
Expires gn6l2022
SEA TURTLE
REVIEW
SUPERVISOR
REVIEW
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NOTARY