HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
9To L CEIS
0
M Aa 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:
Address: TeIIII
Property Tax ID #: Lot No.
Site Plan Name: 0. 11 Co�� Om �' n \` v�II Block No.
Project Name: e—'�111 r �f1t
DETAILED DESCRIPTION OF WORK:
New Electrical Meter )ViFA Second Electrical Meter f
rnNSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
_Gas Tank
4 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Gas Piping
Sprinklers
Shutters
Generator
5q. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer , Septic
Name
lckC DA !.
Address:
City: _� L�'�� t - State:
Zip Code, 3L1G S� _ Fax: -
Phone No. 2
E-Mail: 4
FIII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: Y
.,
Company: _
Address:�S ' ����''�
City::22ti-C.* State:(
Zip Code: ajQqJ0 Fax:7?ZIs
Phone No �— r' �o
E-Mail 72SYVN;�5 'f r
State or County License r by
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC i5 $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: _Not Applicable
DESIGNER/ENGINEER:
�C Not Applicable
Na me:
Address:
State:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Not Applicable
Name:
Address:
City:
Zip: Prone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _� Not Applicable
Name:
Address:
City:
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.
5t. Lucie Counre
ty makes no representation that is granting a permit will abylaws or andpcovenants that may the subject
prohibit such
which is in conflict with any applicable Home Owners Association rules,
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.
rencV review:
The following building permit applications
fences wallspsig si, from
underg rooms and accessoing a full rory uses to another non-residential no niresidential use
accessory structures, swimming p >
twice for
WARNING TO OWNER: Your failto A Notice of Commencement must be a Notice of Commencement may
paying resuilt in hpublic records of St.
improvements to your property. in
Lucie County and posted on the lobommenq n re &wont or rehe first cording Iourr Notice of Commencement' consult
with lender or an attorne before c
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA ((�i
COUNTY OF 'J�
Sworn to (or affirmed) and subscribed before me of
Physical Pre a ce o Online Notarization
th day of , 202/� y
Name of person making statement.
Personally Known /� OR Produced Identification
Type of identification
nll
(Sign tune q Nota`ryPublic- Sta
( f �l 9•)Jpv
Nw" Pubwc swig d
Commission No. 1d*ryUnderHH N
i� es� 24 0
ZONING
REVIEWS I FRONT COUN ER I REVIEW SUPERVISOR
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
t' Physical Presence or Online Notarization
this day of _ 2021,yby
Name of per an making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
r a
nature Notary Publi -Sta Npiary PubwcState of Ftor
( underhiii
Co mission No. �mr'n"en HH 0019:
Expues0511912024_
VIVW
PLANS VEGETATION I SEA TURTLE MRA VG1 EW ROVE
REVIEW REVIEW REVIEW