HomeMy WebLinkAboutfodorAll APPLICBL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: P 'i,o1/� Permit Numbe ':
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Building Permit Applicaticin
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION.
Address: 5IAK^I 5U4Nb4r
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Property Tax ID #: Lot No.
Site Plan Name: Bloc< No.
Project Name:
DETAILED DESCRIPTION OF WORK:
O 01114100tc
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ \ Vindows/Doors _ Pond
_
_ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LES EE:
CONTRACTOR:
Name O OV
Name: Wk ziLei
Company: Ovje—a -
Address:
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City: em- State: -ft,
Zip Code: S I Fax:
Address:
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City: S t State:
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Phone No, `l 3 ' 1(
Zip Code: 3� �QFax:
Phone 2 '(ep
E-Mail:
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Fill in fee simple Title Holder on next page ( if different
E-Mail 01.-w(r qt (
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State Countj/ License RIGS
CAMP l
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencernerh is requirec .
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW WFORMAT(ON':
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPAN If: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phon ?:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phon(:
OWNER/ CONTRACTOR AFFiDViT: Application is hereby made to obtain a permit to do the work and instaiiation 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 hi rider to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenai its that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any re strictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all re pects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Ameni Iments.
The following building permit applications are exempt from undergoing a full concurrency rev ew: room additions,
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WARNING TO OWNER: Your failure to Record a Notice of Commencement may re ;iult in paying twice for
improvements to your property. A Notice of Commencement must be rec )rded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you it tend to obtain financing, consult
with lender or an attorney before commencing work or recording our Not ice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/Li tense Holder
STATE OF FLORIDA �`
STAECOUTNTOY
COUNTY OF �" � a OF %y+1 L)
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) any subscribed before me of
Physical Presence or Online Notarization Physical Prese ce or Online Notarization
this 24_ day of ,�676by this day of 4&2Tby
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Name of person making statement. I Name of person making sl atement_
Personally Known _ OR Produced Identifi tin 8 Personally Known -OR Produced Identificatii
Type of Identification x N Type of Identification
Pro duc Produced a
Sig a e of Notary Public- State of Florida). (Sig a of Notary Publ c- State of Florida)
Commission No.1(Seal)Commission No. (Seal)e
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