HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: .
Date:
Bullding.Permit AP.Plication
Planning ond'DevelopmentServices
Building and Code Regulation Division
,ano vrainla Avenue, Fort Pierce FL 34982
. r•� w C-74
Commercial — Residential
Project Name: _
DETAILED: DESCRIPTION °OF WORK:
,L -
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed
under this permit - check all that apply:
_Mechanical _ Gas Tank
Electric _ Plumbing
Total-Sq. Ft of Construction:
Cost of Construction: $ I
OWN
—Gas Piping
Sprinklers
Shutters
Lot No.
Block No.
Windows/Doors ,_, Pond
Generator Roaf Pitch
Sq. Ft. of First -Floor:
utilities: _Sewer _Septic Building Height: -
Address:
-state. EL
City'
Zip Code- Lii Fax:
Phone No. 7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: ii p
Company
Address: ' / State'
City:
zlp Code- 3 Fax*
Phone No ' ��'
,51
E-Mail � 3�
State o unty License
If value of constntctlon is ?500 or more, a• RECORDED Notice of Commencemeis required.
nt
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: - Not Applicable
Name:
Arlriracc-
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
Address:
City:
zip. Phone:
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.
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 restrictorrppr 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, wails, 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 lobslte before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording Your Notice of Commencement.
Signa re of Owner�Le,.ee�'I.nt,.�Ctor 'Agent Owner Signature of Contractor/License Holder
STATE OF FLORl��} STATE OF FLORI�� I I r i'P
COUNTY OF l�' I'AA f +� _ COUNTY OF
Swo�n to (or affirmed) and subscribed before me of SworD,to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization ✓P�ysicaI Presence or Online Notarization
this day of �CU✓1 120 by this day of;7Rkj,". 20_2,1 by Name of person making statement. Warne of person making statement_
Personally Known
Type of Identification
uced Id1WA66E}fSHN
Notary ublic - State o *n a
TR
Commission # GG 9 6233
mm. Ex fires Oct 6, 2023
p
Bonded through National Notary Assn.
Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known c jo �o*r';
otary u is -State oT"Frrid—a
Type of Identif*. at!ql
7",;
Commission # GG 916233
M Comm. Expires
Produced y pies Oct 6, 2023
fl 1 Bonded through National Notary Assn.
ignature of Notary Public- State of Florida )
Commission No.�"scT�/(�� 5 (Seal)
5UPERVi5OR PLANS VEGETATION SEATU12TLE I MANGROVE
REVIEW I REVIEW REVIEW REVI1=V1t REVIEW