HomeMy WebLinkAboutBUILDING PERMIT APPLICATION /021 08:59AM 7724662999 ALLSTATE PAGE 02/07
ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
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Permit Number: RECEIVED
91To[j UC E12 APR 2 9 1011
Pormltt ng Department
St. Lucie Counfy
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1S53 Fax: (772)462-1S78
PERMIT APPLICATION FOR:
Address:
Property Tax ID#: a, — Q Lot No.a�p
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit—check all that apply.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
_Electric _Plumbing —Sprinklers _Generator (/Roof �Pitch
Total Sq. Ft of Construction: Q Sq. Ft. of First Floor:
COSt of Construction:$ , O Utilities: _Sewer _Septic Building Height:
Name 1 Ail Name:
Address: r. Company:
City: f State:�L Address:
Zip Code:_ Vo1eQ�^` Fax:_1*1 c)-,• L {O -.Q?9'7 City: State:
Phone No. TIo' to kA c{" _ Zip Code: Fax'
E-Mail:_�d�Me,�1C)*-k2gpQt@Copt • Lbf-,t ' Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 250D or more,a RECORDED Notice of commencement is required.
If value of HAVC is$7,50D or more,a RECORDED Notice of commencement is required.
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State;
Zip:
Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not:Applicabie
_
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE ORST INSPECTION. IF YOU INTEND TO OBTAIN.FINANCING, CONSULT
g
R LENDER OR AN ATTORNEY BEFORE RECOkDj;,jG Yn1 iR NOTICE OF COMMENCEMENT."
11 wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE.-OF FLORIDA
COUNTY OFF (1��I COUNTY OF
The foraging instru ien wa acknowledg sd before me The forgoing instrument was acknowledged before me
thisday of 20 by this day of
-�t tj6
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identifica ' nL Type of Identification
Produced Produced
of Notary Public-State of Florida )
(Signature of Notary Public-State of Florida) (Signature
Commission No. .�"""�� KAREI ( NIELSEN Commission No. (Seal)
:.State of Florida-Notary Public
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_• 'c Commission # GO 207484
My Commiss on Expires
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REVIEWS 7nN4qfte 12, S PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER RE VIE '� REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.