HomeMy WebLinkAboutDrew permit appAll APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit
Nmber:
Date:
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Building Permit Application
Planning and DevelopmentServices Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ' Vr) e,
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax !D #:
Site Plan Name: _
Project Name:
DETAILED DESCRIPTION OF WORK:
ZZA
New Electrical Meter. Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.__�
Block No- —
Additional work to be performed under this permit— check all that apply: rs pond
Mechanical Gas dank _Gas Piping
Shutters — Windows)
_ Electric — Plumbing _,Sprinklers
Generator Roof z_Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cast of Construction: $ 0 Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
Name
Address: �� �i ±�� A10 C)
city: State
Zip Code: QJ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company C� �
Address:
city: State+C
Zip Code-aR U. Fax:
Phone No-1 a— W (Q
E-Mail 'r` E i�
state or County License CCU c� SRI
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:
IESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
ame: 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.
l 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,
ntractor as Agent for Owner I Signature of Contractor/License Holder
STATEbF FLORIDFLORRA, STATE OF _ COUNTY F OWA
COUNTY OF CA
SWQeo (or affirmed) and subscribed before me of
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this `-lay of `t , 2020 by
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Type of Identification
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(Signature of Notary Public- State of Florida )
Commission Noe&_01i�5�� Notary uthc
Amanda P Sana
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DATE
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DATE
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Swor la' or affirmed) and subscribed before me of
L--'- Phy Ical Pres ce or Online Notarization
this.,3t�y of + 2020 by
Name of person making state ent.
Personally Known � OR Produced Identification
Type of Identification
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(Signature of Notary Public- State of Florida )
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