HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^� l Date: / _ 3 _ ZoZy Q� f� Permit Number: / l d I V V5?
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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 CBDG Funding
PERMIT APPLICATION FOR: N60 SF I?
PROPOSED
Property Tax ID #:
Site Plan Name:
1PR0VEMENT LOCATION:
n 4-n1 D (L� rr. . Pl snco j rJe i A-J P-,vst- 6-1 miss
3`fo2--- 6w8— 03YI— Ooo/l
Project Name: Ps,160 Pl;S ►y6NCZ
DETAILED DESCRIPTION OF WORK:'
Nc-kl. e.6,5 1400ir _; 3 gs•o , 2 A Z one- GnC°616,
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
V
Lot No. ,3 9
Block No. Y9
Windows/Doors _ Pond
Roof S� v Pitch
S�
Total So. Ft of Construction: 2 22 f Sq. Ft. of First Floor: / Sl
Cost of Construction: $ % r5 � 7St) , pO (t/-)
vgectric vPlumbing _ Sprinklers _ Generator
Utilities: —Sewer Y"'Septic Building Height: A '0 nC+17)
OWNER/LESSEE:
CONTRACTOR:
Name MruJAst- j76►/GLS
Name: C Pb C oc flot4aislo �r�-s•
Address: 590q 13bLrom D►2.
Company: G� b �rwc,r�� 0 vCL- 1 tic
City: F-r. P)--vLGb State:
Address: I''v• 73ay 90196S_
Zip Code: 3`199 Z Fax:
City: Ts L- State: if L
Phone No. 77Z — 5 79 - 7roI E-
Zip Code: 3q 9 6 o Fax: -
Mail: i'2ssfuAux.003C2yo►.AoD,c0Yq
Phone No �72-336-72,go
Fill in fee simple Title Holder on next page (if different
E-Mail GVzG 0- Ge o jol-eG COAL
from the Owner listed above)
State or County License eCzC l s os'l 27
sLx : Z37SS
if value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW
DESIGNER/ENGINEER: _ Not Applicable
Name: , ) .uc ,
Address: ga(, DgcA►,/Yortri Aw
City: V*T . eI b"'L..W State: i L
Zip: 349 ° Phone —/-rz- ybo -77F')
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Snr�b n: own
Address:
City:
Zip: Phone:
NFORMATION:`
MORTGAGE COMPANY: _ Not Applicable
Name: Go_ La �-rc-ti �,o�c , N, A.
Address: 2sys C,01 MGLRAW— 120, 1100
City: State: A Z
Zip: Phone:
BONDING COMPANY: Y Not 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 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
width Ipndpr nr an attornpv hpforp commencine work or recording vour Notice of Commencement.
hat a of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF ST• veld
Sworn t3 (or affirmed) and subscribed before me of ✓
Physical Presence or Online Notarization
this�� day of Sp Y N\J-ry20 3,by
(sisiRG4,otC,y��G� ,5•
Name of person making statement.
Personally Known !✓ OR Produced Identification
Type of Identification Produced
nfy. P
.
(Signature of Public- State of Florida)
Commission No.
�IN
NMq P�g�Qf
AinyE. Scott
asro�anM HH 12 a
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Rev 1U/1Z/Z1