HomeMy WebLinkAboutVincent panel permit,U APPLICABLE CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: Z �
Planning and'DevelopmentServices
Buitdin.Permit Application
Residential V
Building and Code Regulation Division
Z300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPOCATION FOR:
Commercial
PROPOSED IMPROVEMENT LOCATION:
Address: "`'`—' Lot No. --
Property Tax ID #: I Z - dD I Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF`
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply: Windows Doors Pond
_Mechanical _ Gas Tank —Gas Piping _
Shutters _ �
Generator Roof Pitch
/Electric _ Plumbing — Sprinklers --
Total.Sq. Ft of Construction:
Sq. Ft. of First Floor:
utilities- Sewer Septic Building Height:
Cost of Construction: $ 19 � 4 � _�
OWNER/LESSEE:
NameL
Address: � � �J
State-. E
City'
zip Code: I Fax:
Phone No. `1 �— 6
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:Wl
Company:
Address: lo State:- t
City:
Zip Code: :24 91 Fax:
Phone No
E-Mail
State or ounty License �C. r1[�'S 2438
if value of construction is 2Sca 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: State:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address: State: —
City:
Zip: __ Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
eby made to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is her
l certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation me Owners Associetioni rules, bylaws or andpcovenants that maydrestrictbor prct ohibit such
which is in conflict with any applicable
Association and review your deed for any restrictions which may apply.
structure. Please consult with your Home Owners
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, wails, 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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recordin our Notice of Commencement.
Signa re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORA STATE OF FLO IDA
COUNTY OF dt LLf ( <. _ COUNTY OF
Sworn to (or affirmed) and subscribed before me of
1 Physical Presenrtc�e or Online Notarization
this day of J�J,-Z-- , 202A� by
A
o m
-
ame of person making statement.
5
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OR Produced Identification
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ersonally Known
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o
ype of Identification
oT,roduced
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(Signature of Notary Public- State of Florida )
0
(Seal)
ommission No.
Sto (or affirmed) and subscribed before me of
wor
Physical Presence or Online Notarization
this ,(�_—day of 2o2Zby
Name of person making statement.
Personally Known OR Produced Identifica
on.4
Type of Identification
Produced
3 �. = m
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�&Nota�ryPublic-
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Signature State of Florida)
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Commission No. 66 * iv (Seal)
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REVIEWS COUNTER R ROEV[EW S REVIEWUPERVISOR I
REE W I V REVIEEGETATIW S REVIEWLE I MANGROVE REVIEW
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