HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /n( �f
Date: Permit Number: 'wo—y66 J
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential X
I
PERMIT TYPE:SPECIALTY PERMIT
PROPOSED 1MPROVEMENTLOCATION:
Address: 911 EASY STREET
Property Tax ID#: 3402-609-0697-000-4 Lot No.
Site Plan Name: Block No. i
Project Name: EASY STREET PROJECT-WATER INSTALL
.I
pETAILED'DLSCRIPTION OF'1NORK
SET WATER METER TO EXISTING SERVICE AND RUN 1"LINE TO HOUSE AND TIE IN WITH COPPER ABOVE
GROUND LEAVING JOINT EXPOSED FOR INSPECTION.
CONSTRUCTION"INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
i
Total Sq. Ft of Construction: Sq. Ft.of First Floor: !
Cost of Construction:$ $544.00 Utilities: —Sewer _Septic Building Height:
I I
bw"NER/LESSEE CONTRACTOR:,
Name VIRGILIO MOLINA Name:CITY OF PORT ST LUCIE UTILITY SYSTEM
Address:911 EASY STREET Company: I�
City: FORT PIERCE, FLORIDA State:_ Address:900 SE OGDEN LANE
ZipCode: 34982 Fax: City: PORT ST LUCIE State:FL
Y
Phone No (772)222-4695 Zip Code: 34983 Fax:
E-Mail: Phone No(772)873-6400
Fill in fee simple Title Holdall On next page(if different E-Mail UTILITYWATER@CITYOFPSL.COM
from the Owner listed above) State or County License 25597
I �
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 1IEEN 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:
i
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indii ated.
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 YOUR PAYING
TWICE FOR IMPR EMENTS TO YOUR PROPERTY. A NOTICE OF COMMEN NT MUST BE RECORDED AND
POSTED.ON TH B SITE BEFORE THE FIRST INSPECTION. IF YOU INTEN T OBTAIN FINANCING, CONSULT
W R L R OR AN ATTORNEY BEFORE RECORDING Y E F OMMENCEMENT."
Sig re o Own r/Lessee/Contractor as Agent for Owner Signature of Contr for/License Holder
STATE OF FLOR STATE OF FLORI A
COUNTY OF COUNTY OF i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,n+. ,20 by this r2)- day of SQ_t ,20 0 by
�8rart V�ac>z� �rc�,l 1�1�cefC
Name of person making statement. Name of person making statement.
Personally Known ti/ OR Produced Identification Personally Known_./�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign re of Notary Pu IiQ of Floridi4NETTE THOMJ
Sign a of Notary Public- at ,jda) JEl1NE.T.TE THOMPSO
?� ; Notary Public-State _r'�•°= Notary Public-State of FI r a
Commission No. N' •'` C@}�sion#GG ommission No. �` '� ($ mission #'IGG 037 6MyComm. Expires Ot: %FOF FI�Q'O` y Comm.Expires,Oct 14, 0
Bonded through National '"""'"_ Bonded thro
As
New
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.