HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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RECEIVE(
Building Permit Applica ion
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Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMITTYPE:SPECIALW PERMIT
PROPOSED IMPROVEMENT LOCATION:
Address: 709 EASY STREET
Property Tax ID#: 3402-607-0076-000-9 Lot No.27-32
Site Plan Name: Block No. 13
Project Name: EASY STREET PROJECT-WATER HOOK UP
DETAILED DESCRIPTIONO'F WORK:
SET WATER METER TO EXISTING SERVICE AND RUN NEW HOUSE LINE TO HOUSE AND TIE IN WITH COPPER
ABOVE GROUND. LEAVING JOINTS EXPOSED FOR INSPECTION.
CONSTRUCTION INFORMATION-
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ $544.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name HECTOR GOMEZ Name:CITY OF PSL UTILITY SYSTEM.
Address:709 EASY STREET Company:
City: FORT PIERCE, FLORIDA State:_ Address:900 SE OGDEN LN
Zip Code: 34982 Fax: City: PORT ST LUCIE State:FL
Phone No.(786)2307711 Zip Code: 34983 Fax:
E-Mail: Phone No(772)873-6400
Fill in fee simple Title Holder on next page(if different E-Mail UTILITYWATER@CITYOFPSL.COM
from the Owner listed above) State or County License25597
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 LIEN LAW INFORIVIATIO.N:,'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
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 the permit 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 1 D TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING NO;fICA OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 5+.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .20_ by this ao day ofI u r 5t .20� by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known +� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida) (Sign re of No o FI rida)
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE I
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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