HomeMy WebLinkAboutPermit App 6 pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L '11LI[
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 349$2 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
Mechanical `Gas Tank Gas piping LiShutters _ Windows/Doors _ Pond
Electric Plumbing Sprinklers Generator Roof
-- ____ Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ c' V o
Name L U14j,SSts
Address: v� a..3 ,' G o r
Sq. Ft. of First Floor:
Utilities: —Sewer — Septic Building Height:
City: �_ • U . � `ti° Y c --(. , State: LL
Zip Code: Fax:
Phone No. 7 17.2 - $'O - 73
E-Ma i is
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Name: " .e
Company: COA4 .. c/J_.e�a�J��.Ff
Address: .2 3 6' tv r
City. fl rrr State.
Zip Code: I q 9 Fax: 7 Ja
Phone No 7.2 -
E-Mali TO
State or County License g E / s/S^p jo
If value of construction is 25M 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.
9
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
zip: Phone:
Not Applicable
State:
MORTGAGE COMPANY: Not Applicable
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.
1 certify that ntoywork or installation has commenced prior to the issuance of a permit.
St.
is in conflicctt with any applicablerHome Oat wners Asssocing a t opermit will
authorize
or and covenants that mays the subject
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 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 recordin our,Notice of Commencement.
Signature of OwWe'r/ Lessee/Contractor as f J� Agent for Owner Si ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Loci COUNTY OF 4 LAC( G7
Savor 'rmed) and subscri before me of Sworn t affirmed} and subscribed before me of
Ys'r resence or Online Notarization ysical Presence or Online Notarization
t _ day of ( i = by this �Jday of =� � � by
Name of person making statement. Name of person making �—
p ng statement.
of Applicable
Personally Known
OR Produced Identification
Type of Ide ' rcation
Produc 0Ck0 A
iSi9fiature of Notary
li - St e of r o o a
Commission No:�i
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identific
ion,
Type of Identification
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Produced IoQ, Yio � Qiit.�"%
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ature of Notary-F li -
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Commission No. l�c� f
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SUPERVISOR I PLANS I VEGETATION I SEA TURTLE
REVIEW I REVIEW REVIEW REVIEW