HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L S
Permit Number:
(D
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:
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID#: 3VoL— 6c,7— 0LgW — oocv— 5
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
Lot No. 1\
Block No. 36 S
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors _ Pond
`v/Electric _ Plumbing _ Sprinklers _ Generator Koof Pitch
Total Sq. Ft of Construction: �) \\ 5 Sq. Ft. of First Floor: !)\\5
Cost of Construction: $ Z 67, y c) 5 Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
Name I\c.sN
Address: 53og S, p �, ✓
City:�r'("- State:VL
Zip Code: 3`-�ga L Fax: N / A
Phone No. 77k—SSL — 0,8\-{ 5
E-Mail: 3r\g�5 ��a5e C. 5xy\"\ . cow
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: A
Company: (yc. c— M0e�'5 arc
Address:_ 5\\ \�\V�
City: ��c�\ . S" L, State: 1=
Zip Code: 31-05 ) Fax:
Phone No _77L S_)I _ 745 3
E-Mailer $v- zc, ���5 , cc,—
State or County License (—& L S L 117 YJ
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:_��<, ���e_ �5
Name:
Address: oc� P
Address:
City: a*� 9 r Stat .
City: State:
Zip: ' 2-4 Phone_ ny - 6� c _ c)c3s
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPANY: Not 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
Please
structure. prohibit such
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 the Florida Building
plans, 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 ttorne before commencingwork or reco din our otce o Commencement.
S' ature of Owner/ Les Contr or as Agent for Owner
�gnatureV Contra t r/License I er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF f�,h_
COUNTY OF Sj,, LuC w
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_Physical Presence or Online Notarization
F
_pe_- Physical Presence or Online Notarization
this _12 day of r
Zo�z.�bY
this l�.dayof Fcb u 2p26 by
2u�I
_TO\, , 7
ac)
Name of person makin statement.
Name of person making statement.
Personally Known X_ OR Produced Identification
Personally Known OR Produced Identification
Type of identification
��
Type of Identification
Produced
Produced
-k" J"e:4j,
J,
(Signature of o ry Public- S616e of Florida)
(Signature of NofaryStatlef Florida )
Commission No. 41409a50(y (Seal)
l�Public-
Commission No. ('�r1 U&'2.S'ou (Seal)
1 Kelly Finley
`W ,4 ��ey
a�
REVIEWS FRONT
PLANS VEGETATION SEA TU �F £ RU"Id
COUNTER Fi
REVIEW REVIEW REVIE1l1xs�H '" �IH08 5
DATE
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RECEIVED
DATE
COMPLETED
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