HomeMy WebLinkAboutKeith Bullen.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:4Q-4-�--
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
.2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �o-r 4c- I i
Property Tax ID
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OIL WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
Mechanical
_ Electric
Gas Tank
�mbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Name Ke—i
_ Gas Piping
Sprinklers
Shutters
— Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
— Roof Pitch
Utilities: _ 5ewer _ Septic
Address:
City: State:FJ
Zip Code: Fax:
Phone No. _ E
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Company: ,
Address: L
City: State:
Zip Cade: a Fax: . L,29.gY0
Phone No
E-Mail !1 0.P. _ n ; .�.,nl-�,,. Fin. �_,-�. —A .,
State or County License J (�
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:
GINEER: Not
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
e
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: — Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
— 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 far
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
wit lender or an attorney before Commencing work or recordingigur Notice of Commencement.
Slgnature of Contractor - or - owner Builder as applicable
STATE OF FL li D
COUNTY
Swc_rn to (or affirmed) and subscribed before me of
this[� day of 20,by
Name of person making statement.
Personally Known- OR Produced Identification
4pe of Krlification Produced
(Signature of Notary Pubfic- State of Florida)
Commission No. (Seal)
REVIEWS
RECEIVED
DATE
FRONT I ZONING
COUNTER REVIEW
Physical Presence or Online Notarization
Notary Pubfic • State of Florida
Commission It HH 153844
My Comm. Expires Jul 20, 2025
.d through National Notary Assn.
SUPERVISOR
REVIEW VEGETATION
C S REVIEW REVIEW
MANGROVE