HomeMy WebLinkAboutWatts, Donald Gen Permit ApplicationAll APPLICABLF 119 UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — ��_ �� Permit Number:
ST. Li..ICIE
R I D Fa
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
PERMIT APPLICATION FOR:
Commercial
LPROPOSED IMPROVEMENT LOCA____
Address:
Residential
�Qilf,Ir
Property Tax ID #: U
Lot No. j%
Site Plan Name: Block No.
Project Name:
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
Electric _ Plumbing — Sprinklers X Generator
Total Sq. Ft of Construction:
Cost of Construction: $ /d
OWNERAESSEE:
Name
d
_ Windows/Doors Pond
— Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
Address: oL
City: State:
Zip Code: Jr]r Fax:
Phone N�Z��
E-Mail:
Fillin fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 6
Company: •
Building Height:
City: State:
Zip Code: aZ Fax:
Phone N
E -Mail
State or County License &�/, 04Q
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.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDE
Name:
Address:
City: €r,
Zip:Phone:
NotAp'plicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Ph e
Not App 'Fable
State:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a peit 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 recordin our Nce of Commencement.
as Agent for Owner I SignaCGre
STATE OF FLORI STATE OF FLORI
COUNTY OF COUNTY OF Ap�
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Ph * al Pres ce or Online Notarization Physical Pres ce or C Online Notarization
this "flay of 2020 by this day of 2020 by
• �rir11l �`•
Name of personimaking statement. Name of person ml -king statement.
Produced Identification Persona wn OR Pr ced Identificatior�i<
Type d ti, ication^
Pro •�l
(Signature of 'N �� (Signature ot— u icy- Vii% a lord a .
¢° . o ary u rc Mateo .for da
1e/�'f °� Notary Public State of.Florida Charmin D Walker
CommissionNo. Cyarmin D WaNtf'daI1 Commission Y titY Commission GG 22� )
v mission GKT221827 xpiro 6!2022 &qaI
Expires 06106/2022 osc�
REVIEWS -FRONT ZONING SUPERVISOR PLANS VEGETATION' SEA TURTLE MANGROVE
.COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED