HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. Jcc��
Date: Permit Number: / q V e� /J
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Building Permit Application
Planning and Development.Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)-462-1553 Fax:(772)462-1578 Commercial Residential X
PERMITTYPE: NEW ELECTRICAL SERVICE
PRfJPOSEEI IMPROVEMENT C$QCATIZ3N
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Address:
Property Tax ID#: 34) gLt to cot> Lot No.
Site Plan. Name: t ?t Block No.
Project Name:
DETAILEQ DESCRIPTIONhOE WORK � R � �
CONNECT TO BUILDING PERMIT NUMBER 1906-0180Y
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j CONSTRUa�TION INFORIVI�►TIO,N �a `;�� �;� ��-i�' -r� °t-� � �tc,�.��.� F:
Additional work to be performed under this permit—check all that apply:
_Mechanical Gas Tank _Gas Piping _Shutters Windows/Doors
L-lbectr'ic —Plumbing —Sprinklers Generator —Roof Pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ eC^i 0.0 C)C� Utilities: _Sewer _Septic Building Height:
CiWNEIt/LESSEE T Ct�NTRACTOR r yr '
-Name %C f Ct!( f ;,-7— Name:
Address: tG-' ) i irr Com an . ,CLd 6A 1
City: ' i f State:_ Address: . ` o .
Zip Code: Fax: City; �—
Phone No. Zip Code: "t' Fax:
E-Mail: Phone NoI
Fill in fee simple Title Holder on next page(if different E-Mail r" -i '.i1 C +( 4 -_ tY�ris_t COW
from the Owner listed above) State or County license t )` bb 8.1(�
If value of construction-is$2500'or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION Ll�N LAW [NFORMATIC►N
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone-
FEE SIMPLE
honeyFEESIMPLE TITLE HOLDER: Not Applicable BONDING:COMPANY: Not Applicable
PP _ PP
Name: Name:
Address: Address:
City: City.
Zip: Phone: 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 theermit holder to build the subject structure
which.is in conflict with any applicable Home Owners Association rules;bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners.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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR AOTICE OF COMMENCEMENT."
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Signature of Owner/Les /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIRA `
COUNTY OF 61 eeelno mp a- COUNTY OF a nd
The for Ping instru ent was acnowledged before me The forgoing instr ent was acknowledged efore me.
this day of ,20� by this,,day of 20by
Name of person making statement. Name of person making statement.
I
Personally Known OR Produced Identification VIP' Personally Known OR Produced Identification V
Type of Identification Type of Identification
ProducedFLA.b.L.. I&3L. $73 T.L•171+0 i Produced Sk 16:L, A361.873-U-M D
n
(Signature of Notary Publi - t-, FI da (Signature of`Notary Pub c_
r1���U N ENFINGER
Commission IVP MY Co�aw-- ION x GG77020 (+ � Hr1R044���,E,L��jONI ENRNGER
77 fl EXPiiF rcn 13,2021 Commission NoG 77i1 MY GOt�PFi y10N 9 G077020
IMI/ EXPIRES:March 13,2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.2 19 �_..._...