HomeMy WebLinkAboutPERMIT APPLICATION 3110All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: -:>I I L3(31�—ICA 171(.I(4 10 IN
Property Tax ID #: 2 fl['ii1 — ('100 a- C Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical
Additional work to be performed under this permit—check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
r
Generator
Windows/Doors _Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer_,',''Septic Building Height:
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.
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Name
NameC"Z
Addr4ss:'7i) 16 Dd!2c
Company. 5
City J4 Stater
Zip Code: (ASZ Fax:
Phone N;oy
Address: u3 '}% k
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City: icAk' fkv'r44.._
Zip Code: '�3C.)' Li Fax:
Phone No i1—u3'%, � l31-3
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State:
NAPk
E-Mail:T:ti E% IA)'Z\T
Fill in fee simple Title Holder oSn next page ( if different
from the Owner listed above)
E -Mail ` 9 ; 'is 10 desor."2
go
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.
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name) `
the _3 x� � i� � � �� 1 Sub -contractor for c -e A . S �a\�
(Type of Trade) (Primary Contractor)
For the project located at
Street Address or Property Tax ID #)
C`+
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
2XoriI
COUNTY CERTIFICATION NUMBER ����{
State of Florida, County of _�11Xk
The foregoing instrument was signed be -fore me this t 2 day of
I ,20,1by%bEyf A
who is personally known &r has produced a.as�:tiitllW�lllttttteb
HIT
Revised 11/16/2016
COUNTY CERTIFICATION NUMBER
State of Florida, County of AM—Rlwik
The foregoing instrument was signed before me this ii day of
Np'A Ii _, 20� by _ ` , r
who is personally known )4�'or has produced a
as identification.
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