HomeMy WebLinkAboutDemo AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
S"L-I LU,CL.L
`` 0 Building e pp 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: 'DQ
PROPOSED IMPROVEMENT LOCATION:
Address: 5OJj q3 ' af ele-{—
Property Tax ID #: 0 y 01 112 ^ O `-1105— a0o Lot No.
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ yi000
Block No.
Gas Piping _ Shutters _ Windows/Doors _ Pond
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor: 1 ,31K
Utilities: _ Sewer K Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name a P'C .k- w 'L fy o&'V 44b!
Name: -Tc""
C-
Address: -50 9 ) ! , y 3,--.1
Company: Cswza- Q w'6Uz(S
City: T;:y--E- P',e.rr.e- State: Ft-
Zip Code: _3>9 9 u'1 Fax:
Phone No.
Address: SII 5W
PSL &Jd--
City: i S L-
Zip Code: �> A 'D3
Phone No -1 -) -
State: V:L.
Fax:
33U--1U'S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
C), ✓o2�.Ljt�c l derS C�v�
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.
SUPPLEMENTAL CONSTRUCTIO N LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: -Aot 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.
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 attorneybefore commencing work or recording our Notice of Conyneorement.
Signature of O er/ Lessee/Contr ctor as A t for Owner
SignVE
ev.
e of ntractor/Lice de
STATE OF FLORIDA
STA OF FLORIDA
COUNTY OF 5� vkC4 �
COUNTY OF StI�C\ �
S rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
?Q Physical Presence or Online Notarization
this � day of 2020 by
this �. day of OCCCIa10e..� 12020 by
Cn ro2�
J o I.Ln �i-yyo (1