HomeMy WebLinkAboutB dagger 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
grIc LL UrCUE
Planning and Development Services
Building and Code Regulation Division
Permit Number:
Building Permit Application
2300 Virginia Avenue, Fort Pierce FL 34382
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
PROPOSED IMPROVEMENT LOCATION:
Address: (n C`! \ l ,-i ce, --, - Y
Property Tax I D #: `r �-
p Y � A � � ��
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 7�- �--
OWNER/LESSEE:
Nam
Addr
Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Residential . 4
Lt c-1
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer T Septic
City: 1' A a AJC o State:
Zip Code6_�PC5Q Fax:
Phone No. =':_4- �'?3-t���-Lk4D
E -Mail:
CONTRACTOR:
Name:
Compz
Addre,
City: Stater
Zip Code: Fax:
Phone NGI—V:�) - �S�— ��71 ;4 —
Building Height:
Fill in fee simple Title Holder on next page ( if different I E -Mail
from the Owner listed above)
State c
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.
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zi P.
Phone
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
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.
nature of Owner ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF r1
Sworn to (or affirmed) and subscribed before me of
_',�ysical Presence or Online Notarization
this day of eW����— 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Typof Identification
11L/ced,-----,_
Tgriat'6re of lic- State of Florida )
Commission No. NoWY P Sum of F�
,p" Kevin D Cook _� .,.QAR,
S�igmafure of Contractor/ -License Holder
STATE OF FLO,� IDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Pr ence or Online Notarization
this day of ` _ 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produ e
(Sig atu a of Notar - e of Florida }
Commiss n No.c_ 011i
r ,►% Kevin D Cook
Rev. 5/ b/ Zu
Expires
127/2023.yamExpire3REVIEWS
FRONT
P
PLANS
VEGETA
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COUNTEREVIEW
REVIEW
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REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/ Zu