HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -7' -' 'toZ-( Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: t—:
PROPOSED IMPROVEMENT LOCATION:
Address:
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Property Tax ID #: -[ `-t-2�2_ 5y Z — Z70Zj Lot No. 1
Site Plan Name: Block No.
Project Name: 6�1� SLG1eSr aiG�
I DETAILED DESCRIPTION OF WORK: I
1nS+7,t( Z An J 160 Jilin _3o-g(F) roeLln jusi
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
—Mechanical
V/ /Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_Sprinklers
(Affidavit required)
_ Shutters Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNEAR/LESSEE:
CONTRACTOR:
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(Vl,i Name (; 16(
Name:
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Address: [ Z (Qq �IVey6a e
Company:5001'IC!/i
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City.T4 -+ S r //��i✓�LCI 'L State: l�
Zip Code: 7J'i'"1 7�' Fax:
Phone No. 407 2- C1032
Address: 11004
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City:
Zip Code:
Phone No
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5b/ • Z 004,
State: T�4-
Fax:
10415S
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E-Mail: WjlqYr eScti CD UI 1 bDIL. CCM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail IRryyi I & LP 5ot&Aq-m Ce1aP sev✓icg, (�L
State or County License 5L7 1 sco 497Z)
u veiue ui construction is cauu or more, a ntcurcUtU Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 Applicable
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 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.Wornw bef commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
EeaC6
COUNTY OF 01
Sworryto (or affir d) nd subscribed before me of hysical Presence or Online Notarization
this 2014 by
,i! a (a
Name of person making statement.
i1__�
Personally Known OR Produced Identification
Type of Identification Produced
(Signae4,bf Not ry Public- State of Florida )
;oi�r?�•• TIFFANYTOPCI
C�G� (Seal) ;' *: A4y COMMISSION # GG 347505
Commission No. J Seal
EXPIRES:Octoher20,2023
BondedThruNotaryPubHeUnderxriters
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