HomeMy WebLinkAboutPermitApp.pdfAll APPLICAB E INF UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,2 Permit Number:
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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
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address: c.>6 L) VAQVN1KX;s j)0Vt (. 1 1 11010 '�yT-N1 L,uc-V-eI r� iaec
PropertyTax ID #: 9'd-5 - 70� `0075'Ot-7 Lot No.
Site Plan Name: Block No.
Project Name: kx-NAr7 L, &5: 7 mce
I DETAILED DESCRIPTION OF WORK:
�3.17 -rnKI . 1y.5 SakE /0kv.i(Wem-) 7cHN-r sk 't-kvwvc UNri
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
X Mechanical _ Gas Tank —Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: I TS LAwpm AC2
Cost of construction: $ 5 R A S
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L- Lv/AW E f`( at
Name: MARK
Q V=MES
Addr s•
City: VORT SATA17 I 1ACTr State: FL,
Zip Code: 34 q S- Fax:
Phone No 17 U 7 - e,SJ I I
Company: ftr;TZ1 Thl(_•
Address: 25q A S kri rrAPLY TP L
City: l CAC State:
Zip Code: 3�%Li IS Fax:
Phone No (.I - a I g 7
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the owner listed above)
E-Mai( rMl t'S Q e ( i
I QC. • Com
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State or County License llAC OLI 025 3
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.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 i aying twice for
improvements to your property. A Notice of Commencement must be record n the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you inte o obtain financing, consult
with lender or an attorney before commencing work or recording our Notic f Commencement.
Sig natu a of Owner/ Lesse Cont tpor as Agent for Owner
Signature of ContractZArise Holder
STATE OF FLORIDA
I.UG=E
STATE OF FLORID
LU.CZr.
COUNTYOF .SA=I-jT
COUNTY OF NT
Swor to (or affirmed) and subscribed before me of
Swor (or affirmed) and subscribed before me of
Ph sical Pre ence or Online Notarization
(�C
Ph sical Presence or Online Notarization
this day of 204by
this day of JMIZCA— 202&by
L11-G_V rJ RUNIAGEL
MAU A Urm.<
Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of I entification �
Produce
Produ
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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