HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION,
Address: 4002 Avenue K FORT PIERCE FL 34947
Property Tax ID #: 2405-601-0579-000-3
Site Plan Name: Smith
Project Name: Smith
UPGRADE LATERAL AND GROUNDING
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
IV
l lectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ iUtilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ruby Smith
Name:CHRISTOPHER SHAW
Address:4002 Avenue K
Company: FPL HOME SERVICES
City: FORT PIERCE State: _
Zip Code: 34947 Fax:
Phone No.
Address:6001 VILLAGE BLVD
City: WEST PALM BEACH State: FL
Zip Code: 33407 Fax:
Phone 1\10561-747-5740
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MaiISTEPHANIE.KUSSRATH@FPL.COM
State or County License EC13009228
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State.
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
P\ &OC'V
COUNTY OFA F
T
COUNTY OF
Swo n to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
hy�ical Pres nce\or Online Notarization
this Sday of 1 - 2020 by
c� Physical Presence or. Online Notarization
this day of �t�lL , 2020 by
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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
Prod ed.
(Signature of Notary Public- State of FI d ' "'
Signature of Notary Pu ic- State of Florida
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