HomeMy WebLinkAboutfodor0001All APPLICABLE FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 y "101'1 Permit Number
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Re! idential
2300 Virginia Avenue, Fort Pierce FL 24982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: �epj J_�+ W;J,� }�
PROPOSED IMPROVEMENT LOCATION:
Address: �> SL4 AerI otJ W 3� t
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 _ Vr indows/Doors _ Pon
_ Electric Plumbing _ Sprinklers _ Generator _ _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 000 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I N P Name: I Ik—
Address: 2&Y1 (044W WkA Company: 't S
City: - State: Address:
3`� j ����
Zip Code: Fax: City: 5`W State:
Phone No. Zip Code: Fay
E-Mail: 0V Q i AAA • 62" Phone 1 Z- 631� R g I S
Fill in fee simple Title Holder on next page ( if different E-Mail l % VQ g _
from the Owner listed above) State CouPty License C� t�
of construction is 2500 or more, a RECORDED Notice of Commencem nt is required.
of HAVC is $,7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPAM': _ 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: Phone
UWIVtK/ CON 1 RAl ACTOR Hrr1UV11 : Application is hereby made to obtain a permit to do he 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 he der to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenar :s that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any re: tractions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all res )ects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amend rents.
The following building permit applications are exempt from undergoing a full concurrency revii m: room additions,
WARNING TO OWNER: Your failure to Record a Notice of Commencement may re! ult in paying twice for
improvements to your property. A Notice of Commencement must be recc rded in the public record of St.
Lucie Country and posted on the jobsite before the first inspection. If you in- end to obtain financing, Oonsult
with lender or an attorney . before commencing work or recording your Not ce of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/Lic ense Holder
STATE OF FLORIDA STATE OF FLORIDA
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COUNTY OF E� t COUNTY OF �C I (1
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or; Online Notarization Physical Prese ce or Online Notarization
this � day of ,;e7 by this day of 4e2Tby
� Zo 21 2021
Name of person making statement. Name of person making st itement.
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Personally Known OR Produced Identifi tin o Personally Known ✓� OR Produced Identificati 51'
Type of Identification e i N Type of Identification
Produce " Produced a
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Sig a e of Notary Public- State of Florida) F (Sig e of Notary Publi :- State of Florida)
Commission No.1+ (Seal) .0t Commission No. ## e) 3 Est (Seal) ►e
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