HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLIC/AB E INFO MUST BE CGr',w='ETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
By .� FED 0,.i .2g2
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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:
Address:! Q I :r,//-
Property Tax ID #:
Site Plan Name: O
Project Name:
C7ETAIL�D DE5CR1pTIC
e�
1i. 0 �Ji
z.
^66ati0o03-C)IDa
Res C3VYi
toe, P',
LJ
3 01Y -
New Electrical Meter Second Electrical Miter (Affidavit required)
Additional work to be performed under this permit
Mechanical GasTank —Gas Pipi
�lectric Plumbing _Sprinkle
Total Sq. Ft of Construction:
Cost of Construction: $ `✓/ ��
Na me "tk>(E__ J-%r4-fL,0 Y6
Address:
City: _�y /z"! State
Zip Code: 3 �% Fax:
Phone No. g 3
E-Mail:
Fill in fee simple Title Holder on next page ( if diffe
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED N
If value -of HAVC is $7,500 or more, a RECORDED Notice
check al -I that apply:
_ Shutters
Generator
Lot No. .3
Block No. os-&
f/ Windows/Doors _ Pond
�oof Pitch
Sq. Ft. of First Floor:
lities: —Sewer —Septic Building Height:
:Address:
City: State:
Zip Code: Fax:
Phone No
it E-Mail
State or County License
of Commencement is required.
mmencement is required.
E
,
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4mr��..yg � NNST 11""�'!!,"
,.. -Fs�'
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DESIGNER ENGINEER• 1 _ Not Applic ble
.
�S '
MORTGAGE COMPANY: o't Applicable
Name: 02.
Name:
Address: 00. b aC_
Address:
City: rde6 gQuAi Stater
City: State:
Zip: a Phone 772-- ,-- I 71-- 92—
Zip: Phone:
.
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address:
_City: City:
Zip: Phone: Zip: Phone:
I
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,repres2ntation that is gr6nting1,&permit.will authorize.the: permit holdeF,to:build�.the subject•stOcture
which is in conflict with any applicable Home Owners Associatioh rules/bylaws or covenants that'may restrict
and of prohibit such
structure:; Please consult with your Home Owners Association and_review'yourdeed fQrany`r estictions which may apply.
Inconsideration 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,Arnend'rrients.'
The following building permit applications are �xempt from undergoing a full'coloicurrency.. 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.jo site :before,the:f�rst'inspectlgn. If you iiltehd=to obtain'fina.ncing :cons/ialt
with ,lender or a6 atforne �b fore c,ommencin 'Iwork or recordin ° .our Notice of Commencement.
. � .-• - \ 51.E '� � ._ n .-.,_ '1 .i s \
r,
�YP„e,,, .HEATHER'B`URFO'RD
_Slgiiature oTf(7nRQ /Lessee/Contractor as Agent for Owner ;_Lam,State of Florida -Notary Public
Commission # GG 183217
My Commission Expires
STATE OF FD '"II�� `"' February o6, 2022
COUNTY OF
Sworn to or affirmed) and.subscr'ibed before me of _IZ/Physical Presence or Online Notarization
this %� day of
Name of person making statement.. ".
Personally Known�OR Produced Ide
tification
Type entification:.Produced"
•.'
(Signature of Notafi Public- State of Florida )
Commission No.
PEDROMALONSO ^' ? •• •' -
o
* commission # GG 297802
Expires February 23, 2023, •ti I i -
9rFOFF
eQ l
Notary, ServloN
LgP�
BoadedThru Budget
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