HomeMy WebLinkAbout6005 CassiaAll APP��LICJJABLssE INFO MUST COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:`y-fit$ � �/ l . Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial _ Residential
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMJ�M
Address:QQ
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _PasTank _Gas Piping _Shutters
_Electric /Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
_ Windows/Doors _ Pond
_ Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWN LESSEE:
CONTR R:
Na e
C
Name:
Ad
-cmpa y:
G State
Zi Cod Fax:
Phone No.
Ad ess:
C)[y: State:
Zi ad Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail}Qj�
_
Stateq�-
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 LI LAW INFORMATION:
DESIGNER/ENGINEER: _ N Applicable
Name:
MORTGAGE COMPANY: _ N pplicable
Name:
Address: X
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE H DER: _ Not Applicable
Name:
BONDING COMPANY _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ tONTRACiOR AFFIDVIT: Application is hereby made to obtai a permit to do the work and installation as Indicated.
I certify that no work or installation has commenced prior to the Issuance o 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.
Inconsideration 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 attorney before commencing work or recording vour Notice of Commentement.
Z.
Signature of ner/ Lessee/Contractor as Agent for Owner
Signatur&bf Contractor/Li ense Holder
STATE OF FLORID
STATE OF FLORIDg f
COUNTY OF 11 fAe—)
.
COUNTY OF �Ji.LUGt1�
Swos to or affirmed) and subs ribed before me of
Swor9 to (or affirmed) and sub abed before me of
V Phy iwl Prese a or Online Notarization
✓Ph sical Pres ce or Online Notarization
this a o 024 by
this ay of by
Name erson making statem t.
Nam on making statement.
Personally Known v/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
- Sign u. rl�`bt;{�otar� - iFl�ri )
Pub a e o or a
(Sig tt{ce Notary d�tlBR1:"'J1 f or a)
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Boncet thro6gh National Notary MSn.
Boreea uxoLgh National Nltary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.5/6/20