HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE,INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. _�n zGzz-
Permit Number:
goo Luccu�
u LcWl* 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) C
PROPOSED IMPROVEMENT LOCATION:
A l i . %
• /�:ilk::"li�l'�TiTi��„l�Tr•'�i'l.'�l
Property Tax D• M
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK:
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
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: cc 77��
Cost of Construction: $ �5RLA •�D
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Utilities: —Sewer _ Septic Building Height:
OWNERAESSEE: -
CONTRACTOR:
Name
Address:
City: State:EL
Zip Code: �1'� Fax:
Phone No. E-
Name:
Company: �_ firs n C038ha icb _W
Address: I
City: , State: L
Zip Code: S'Ap1Wl_" Fax:
Phone No-1-1 2. U! -11
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail-I
State 014ounty License %c C j212 sb
" UC uwi1x1 u1,uun is cavu ur more, a KcwKutu NOTtce OT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ,G Not Applicably
Name: 7 —
Address:
City: State:
Zip: _ Phone
FEE SIMPLE TITLE HOLDER!
Name:
Address:
City:
Zip: Phone:
*G Not Applicable
MORTGAGE COMPANY: 7 Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: 52�Not Applicable
Name:
Address:
City:
Zip: Phone:
W W V Lin/ ..vIV i nr►a.l vR mrriuvi 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 before cornmPnrina %A,nrie nr rnrr%rr1;nn .,,, ,.F,-
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Signatu a of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
to or affirmed) and subscribed before me of
' 21
Physical Presence or Online Notarization
this
this ay of , 207/--yy
Icy
Name of person making stat ment.
Personally Known OR Produced Identification
Type of Identificati n roduced
avVE
=' ?.7... KATHERINE 14AP�S
`@ MY COMMISSION #HH,a
; EXPIRES: DEC99309
C G4. Z i95
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Bonded through t v ; )t� &r 9 a insurance
(Si nature f Not u ic- State of F rida)
Commission o. (Seal)
= pRYALeG KATHERINEW/F4S
.. MY COMMISSION••#Hw,; 93o9
EXPIRES: DEC_ o4 2P2t
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Bonded through Is! S(a e !nsurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10112121