HomeMy WebLinkAboutMidway Vet permitAll APPLICABLE NFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c Permit Number:
Building Permit Applica
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Fi 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: u�' ff
Property Tax ID #: 'ca - C? - 03 _ i Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
M
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
— Electric ____ Plumbing _ Sprinklers —Generator _VZoof Pitch
Total Sq. Ft of Construction: acL Sq. Ft. of First Floor:
Cost of Construction: $ ( utilities: —Sewer —Septic Building Height: � l
OWN ER/LESSEE:
CONTRACTOR:
Name
Name: and
Address: 1
Company.
Address: 5
i L/�
City: i Sta e:
Zip Code: ) Fax:
Phone No.
City: '0 .Yl
Zip Code: C7y Q.' Fax:
Phone No -1-1 c)' 9-1S- (Q IC
State'.
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail - i* 0 A -C- % f 14CXJ,1 t-0
State or County License Sc
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City State:
Zip: Phone:
FLEE 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, 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 recording our Notice of Commencement.
Signa re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR
COUNTY OF (f,
STATE OF FLO
COUNTY OF
Sworn to affirmed) and subscribed before me of
sical Prqsepce or Online Notarization
this day
�off f 2020 by
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SworD,"-(or affirmed) and subscribed before me of
�- Physical Pre ce or Online Notarization
this day of 2020 by
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In Lox
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Name of person making statement.�
Name of person making statement.
Personally Known 1 ` OR Produced Identification
Type of Identification
Personally Known L, -----OR Produced Identification
Type of Identification
Pro ced
Pr uced
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expires 04125/2022
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
ETATION SE URTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/15/20