HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST 6E COMPLETED FOR APPLICATION TO.
BE ACCEPTED c�
Date: Ml
Permit Number:Z M.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 ReS I d e I1 tI a I
Phone: (772) 462-1553 Fax: (772)'462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
1 j—<--
New electrical Meter n1_C_) ' Second Electrical Meter
Lot No.
Hoaitional work tb be performed under this permit— check all that apply:
—Mechanical — Gas Tank — Gas Piping Shutters
Windows hors _Pond
— Electric — Plumbing Sprinklers Generator _<
— Roof Pitch
Total Sq. Ft of Construction: 2j2�6
Sq. Ft. of First Floor:
Cost of Construction: $ ��Qi UC�(� Utilities: —Sewer _Septic Building Hei ht: 'e�J/'�
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Name --V �; dk
' �
Address:) ) t7J
'�'``� ��
Name M �
City:
State•
Company:
Address:
Zip Code: Fax:
Phone No. p
`�
City: State:
E-Mail: �1�p C72—
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Zip Code: Fax:
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Fill in fee simple Title Holder
Phone No
on next page ( if different
from -the Owner listed
E-Mail
above)
State or County License
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.
MIm
Name:
Address:
City:
Zip: Phone
State: —
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City: h e
MORTGAGE COMPANY: _
_. licalale
Not . pp,; .
Name: _
Address:
State:
City: Phone:
Zip:_
�_....,.
BONDING COMPANY:
Not Applicable
Name:
Address:
City:
Zip:
Zip: Pon
OWNER/
CONTRACTOR AFFIDVIT: Application is hereby made to obtain apermit to do the work and installation as indicated.
f certify.that no work'or mstalletion-has:commenced pnorto the issuance of a permit '
g' P b laws oche covenants that may restrict or prohibit such
t. Lucie Coun makes no representation thatOWne stAssociatl n rules Lbylawize the per a holder or
whichemay1ap ect structure
s applicable Home
which is in con-lict with any app ' erform'the work
structure. Please consult with your Home Owners 'Association and review deed' or y
ree that I
In consideration of the granting f this
srthe Floe duested a Building Codes aI do nd St. Lucie County Amendml, in all e nts.
in accordance with the approvedP ,
The following building permit applications are.exempt from undergoing a full concureview: room additions,
accessory structures, swimming pools; fences, walls, signs, screen rooms and accesssoryory uyses to another non-residential use.
u
OWNER: Your,.failure to Record a Notice'of Commencermust be nt recorded pn resiilt in tFie p bl c �ecords of'St.
WARNING TO.OWNER: Alt
' Notice .of`.Commencement
improve.ments'to your property.
Lucie County and posted on the jobsite:before theork or re ordinn to nNot ce of CodAbommencementgfinan ' consu
with lender -or an attorne before co mencin w
Signature o� /Lessee/Contractor as Agent for Owner
STATE-0F,FLORIDIA-
COUNTY;OF
Sworn to (or affirmed) and subscribed before me of
Pres ce r Online No nthisITI,ical
d'ay of 20O�Jby
Name of -person making statement. ,
Personally Known __ OR -Produced Identification v
Type of Identification
Produced �1
of Notary lic- St a of Flo�la) , ,
Commission -No. Yb SHAHNAINO M�I t1m�n�+
...a�•. G(3 77509n
�° A. ° MY cOMMrssol #i
REVIEWS I _F vex"' - iFW REVIEW
RECEIVED.
Signature of Contractor/License Holder .
STATE OF.FLORIDA
COUNTYOF : .
sworn to (or affirmed) and subscribe _:—online fore me i tiofn
Physical Presence or J 26_ by •
this day of
Name -of person making statement:
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
PLANS VEGE7:1EA TURTLE MRE EWVE
REVIEW REREVIEW
I