HomeMy WebLinkAboutBuilding Permit Application All I AP PUCIABLE I N FO M LIST 8 E CO M PLFTE D FOR APRLI CATIQ N TO BE ACCEPTED
Date' Permit Number-
Building Permit Application
Prcnarng Und velopmen t sorvlces
Building and Fade Regubtion Division Commercial Residential
2300 Virginiv Avenue, Fort Pierce FL 34982 '
Phone, (772) 462-155.3 F�x; (772) 2-1573
PERMIT APRLICAT;ON FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: f - + � -
Proper ty Tax i13#: - t -- dot Nc). L
bite Plan Name: Block No.
Project Name: Rik G
DETAILED DESCRIPTION OF WORK-
New Electrical meteT _ Second Electrical deter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas I ank _(5as Piping Shutters indlows/Doors Penct
— Electric — Plueobing Sprinklers _Generator Roof Pitch
Total Sp. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction: S ��,� Utilities: _Sewer _septic Building Height- �
OWN ER/LESSEE: CONTRACTOR: ---
. _ -�
Name { � 1 � dame: -
Atidress. y� _ ,
•� �.._ . z� Ici i E* �- „ Corn pa n &'► J}t_
I
City: State: Address.
zip Code: 3q % k Fax: C itv: n eat :
Phone No,� - � ! 'f� Zip Code; Fax:
E-Mail: � �.. Phone No L
Fill in fea Simple Title Holder on next page if different E-flail- _ (L�,) ta- ) rrLt 1( rl "k
frog the Owner listed abave) Ut r C my License -( I
if Va l ue of r on Gtru cu on is 25-DO or more, a RECORD ED Notice of Commencement is requ ired.
If va I ue of HAVC is S7,500 o r mo rye, a RE£OR'DE D Notice of mmen rent is re q uired,
FPPLE ENTAL CON TRUC- PON LIEN LAW INFORMATION:
DESIGN E ENGINEER; Not Appli-cable— M0RT AGE COMPANY; Not Applicable
Name,, Marne:
Add ress: _ Address, -City- '
ttit?yr: _ State:
�P: Phone_ zip:
FEE SIMPLE TITLE HOLDER. Not Applicable BONDING COMPANY: p lot ApplicabJe
Name., Name-
Address:_ Address:_ -
C-rty-, City-
Zip: Phone-, Zip: Phone.-
OWN ERI CO NTRACTO R. AFF]L)VIT. Application is h ereby ma dc,to o bta in a pe rMi t t(>do the work a n d i nstai I ati on as indicated_
I ce:rtify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is grranting a permit vAll authorize the rmit#holder to buid the subject strycture
which is in conflict with any applicable Horne Owners Associatian rules, bylaws or a na covenants that may restrict or prohibit such
structure,. Neale consult with your Home Owners Assaci;atlan and review your deed for any ros#i ons which may apply.
In cons I de ration ofth2 grariting of this requested permit, i do hereby agree that I will, in .all respects, perkrrn the work
in accordance with the aloproved plans, the Filarida Building Cod ffs and St, Lucie County Amendments.
The f❑ilowing building permit applications are exempt from undergoing a fuIf concurrency mview: roorn additions,
accessory structures, swimirning pawls, fences, walls signs, scr-een roams and accessory us,-_5 to another ,tan-residential use
WARNING TO OWNER: Your failtare to Re rd a Noti-ce at Carnmencement may result in paying twice for
f m p rove rn e nts to your property. A Notice of Commencement must be recorded in the p u b I is records of St.
Lucie County arnd posted on the jobs ite before the first ins.pection. If you intend to c)bta1n financing, cons Ult
wi t h I e n de r air a n atte rney before com m e ncii ng worIC or recording o u r N otice of Cc rn me n cem a nt.
1 Signature crf Owner/ Less'eejContractor as Agent for Owner Sign t_ure_ of Contra rf Liceme Holder
STATE OF FLORIDA STATE OF FLORIDA
CO U NTY OF _ COL!NTV O F
Sworn to for affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
P hysica I Presence or_On I Poe N otarizat-pen Physical Prese nce or_0 n line N eta rization
this .)J.�i_daV of f 1 . 2020 by this � day of # Pf Z020 by
�If-� 4 11 ■
N a me of Pe rson make ng statEment. Name of person making staternent,
Persona I ly Known 0 P P rocl u ced I d entificatio n Personally Known� OR Produced Identifiowtion
Type of identification Yype of Identification,
Produced Plre6uced
� i tore of fro wry} ulalac- Stag €xf Florida j ( azure of N tary Puhlic- State of Florida �
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DATE I _
RECEIVED
DATE 1
COMPLETED � I ...
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