HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: Permit Number: 0.>;J • o n i
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Building Permit Application
Planning and Development Services
Building and. Code Regulation Division Commercial Residential
. Xel
2300 Virginia Avenue, Fort Pierce FL 34982-
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG .Funding
PERMIT APPLICATION FOR:
Address: ,33 ) ri I N ornes D r. R• Aeac.e.1 , FL. - 3 `f•/i L�5
Property Tax ID #: a3a1- sot - DUI Co l)- Lot No.$_
Site Plan Name: N 1 A+ Block No.
Project Name:
TJqL-L ISIZECIL Arni
PJ k*T5 /-a� Uo" LA
i f - r ailee" - vrr�
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
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Name 1'ti7A" c i�c7
Name' C.1QtL:tiJ�r
Address: 331A 44n►-2g*S DY-
Company: TVA.c rhu-, c %. U e-
City: - • Ph2LGe.0 State: FL.
_
Address: _ 1131Gi SW � P P1fa k.. i9 ►'.
Zip Code: 3 IFS' Fax: _ N1�
City: TOO 14. Luu.4� State: R .
Phone No. C15q- :j:50- SO i a E-
Zip Code: ti8'7 Fax: FJI&
Mail: rY10940 PO i I -
Phone No77.;t -332 -aS6/2
Fill in fee simple Title Holder on next page (if different
E-MailThAdih avirepgj, � LPi ! lrna;1. Wry-N
from the Owner listed above) -
State or County License , 31 O-13
L, VaUc U1 1.o,,5uuczi0n ,s cauu or more, a ntcursUtu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SU RC t' � CO j (�� j;
DESIGNER ENGINEER: _ Not Applicable
:NORM r:WO h ='
MORTGAGE COMPANY: Not Applicable
Na me:
_
Name:
Address:
Address: Al I
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:
P h o n
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 agreethat 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-70.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 attornev before rnmmpnrino wnrle nr rprnrriina vniir Aln+irp of rnmmunramont
ractor - or - Own r uilder as applicable
Signature70MMf
STATE RBCOUNT1,11 lil
Sworn (or affirmed) and subscribed before me of Physicai Presence or Online Notarization
t
this t day of MQCCi("1 202: by
Jese h. M c FCC Y _
Name of person making sta ment.
Personally Known OR Produced Identification
Type of Identification P oduced .
(Sig a re of Not Public- State of Florida)
Commission No. (Seal) f '° 11'WUN AUNMYOUNG
WCOMAIISSIONSHN 10W
�p•,r`' EXPIRES: February 18, 20X
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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