HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED T.
Date: �'' Permit Number: 05
RECEIVED
Building Permit Application
Planning and Development Services FEB 22
Building and Code Regulation Division Commercial Residentiad Le County
2300 Virginia Avenue, Fort Pierce FL 34982 N Permi$mg
Phone: (772) 462-1553 Fax: (772) 462-1578 P - J— ^ _ A�
PERMIT APPLICATION FOR: (�2� MA-11)
address: ® ldO Se4 -AW 11:' RI;riD 'Y®f
Property'Tax ID #: 2-4:8 '702
Site Plan Name: h;
Project Name:
ff ONn aE)e some Wdr or 1—
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No.
Block No.
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: 62-14 Sq. Ft. of First Floor:
Cost of Construction: $ 2.00 a , (fie Utilities: —Sewer _Septic Building Height:
Name &mni_��
Address: q O.4; "�sc�oct;
City:tr IFc'_. ;. r Y' '$tate:PL
Zip Code: -'Fax:-
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:3UJ Ql n%F0160l- l LC-JR,&QLC'_ps
Company:
Address: 26 6a SW l Mr'orx _ .
City: parr S ; +" UCA E State:�L
Zip Code: Fax:
Phone No - tK--6 ( 6 S S.S'3 S' I
E-Mail_,���
State or County License C6C 1.0 (1 S 9 '7
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.. ;
DESIGNER/ENGINEER: _ Not Applicable
Name: (3r-_m)Aarz6
Address: 11!�6 -T� &U
City 111 �u4�r £si _State: EL
Zip: 3341 A Phone 161 '7t8 -
FEE SIMPLE TITLEHOLDER: — Not Applicable
Name:
Address:
City. c _
Z Phone: v,
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
�ldclre�s:
l Cit�,
Zip: Phone:
Not Applicable
State:
Not Applicable
ip.
ade to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby m
I certify that no work or installation has commenced prior to the issuance of a permit.
it
r to
ect structure
St. Lucie County makes no representation
eion that
Owners ingocperm.i rules, or andthe pcovenannts that may drestrict the bor prohibit such
which is in conflict with any pp
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the
granting of
plans, srthe Floe da Building Id ng Codes and Stdo hereby e Lucie Coue that I fnity Amendments.
hethe work
in accordance with t pp
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
lt in
or
WARNING TO OWNER: Your failure to A Noticda Notice of Commencement may-res
e of COMMen ement must be reco1rded paying
the publicfrrecords of St.
improvements to. you property.
ropertY ins
Lucie County and posted on the jobsio the first
repo di n Iconsult
your Notice of Commencement.
with lender or an attorneybefore commencing
Signature of Owner/ Lesse ontracto Agent for Owner
STATE OF FLORIDA
COUNTY OF K-
Physical Presence or
Sworn to (or affirmed)_and subscribed bef re me of
this lday of 20by
Name of person making statement.
Personally Known OR Produce Identification
Typeof Identification Produced J
(Signature of Notary Public- State of
Commission No. (Seal)
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DATE
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Online Notarization
HEATHER BURFORD
Notary Public -State of Florida
Commission # HH 218910
My commission Expires
February 06, 2026
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