HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
CEO V.
GaIca: 1� I o
Permit Number,*, 0000�
Building Permit Application
Planning and Development Services
Building and Code Regal Lion Division
2300 Virginia Avenue, F�rt Pierre FL 34982
Phone: (772) 462-1554 Fax: (772) 462-1578
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Commercial f � Residential
New Electrical Meter I Second Electrical Meter (Affidavit required)
CONSTRUCTION (INFORMATION:
Additional work to be
performed under
this permit — check
all that apply:
Mechanical
GasTank
Gas Piping
Shutters
,� Electric
Plumbing
� Sprinklers
_Generator
Total Sq. Ft of Construction.
Cast of Construction. $ &I 330e 00
OW N E R/LESS E E: �
Name
Address:
city:
Zip Code:
Phone No.
E-Mail:
C, 3
r'n 4.
L
r
✓ Windows Doors
mmmp�
tot No.
Block No.
Pend
Roof Pitch
Sq. Ft. of First Floor:
Utilities: � Sewer r, Septic Building Height:
State: �P/
CONTRACTOR:
Name:
Company:
Address:.o
Fax: City.
Fill in
fee
simple
Title
Holder an next page ( if different
from
the
Owner
listed
above)
rn S
V State.
Zip Code:
Phone
E-M l
State or County License
If value of construction il� 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTA CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:
Address:
City: � ; -- � � State:
Zip: lPhone
FEE SIMPLE TITLE MOLDER: _Not Applicable
Name:
Address:
city.
I
Phone:
Name:
Address:
city: State.
Zi : Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
i } Pone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l certify that no work 010installation has commenced prior to the issuance of,a permit.
St. Lucie Count ,makes no representation that is granting a permit will authorize the permit Folder to build the subject structure
which is in conflict witH any applicable Home Owners Associat Ion rules, b l �s r and covenants that may r e trr t or prohibit such
structure. Please consult with your Home Owners Association and r i r 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 Fiarida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions{
a c sso ry st ructu res, swi mm ing poo Is, fen ces, waIIs, signs, screen morns andd a ccessor uses to another non -re idential us
WARNING TO OW14ER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements a your property.. A Notice of Commencement must he recorded in the public records of St.
Lucie County a d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or ala-attornev before commencing v+rvrk or recording spur Notkv'�ommencement.
l
tore of oven sseefor as Agent for Owner
STATE OF FLORID b
COUNTY Of M'I offis°—
1�Swa n to for affirmed) and subscribed before me of
P ysical Pres nc or � Online Notarization
th��day of 2020 by
Name of person making statement,
I
Personally Known
Type of Identificat
Produced - �
�q
S�
i gnatu r Contract
STATE OF FLORIDA
COUNTY OF M-Aa
License Holde
01
Sw�to (or affirmed} and subscribed before me of
P_h�sicai Present or Online Notarization
this�"� day of 6, 2020 by
Name of person making statementO
I
R Produced Identification Personally Known Produced Identification
i Type of Identification
Produced
(Signature of Notary Pubiic7kate of Florid
CommissionNo. � �� � �`.
REVIEWS
DATE
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DATE
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F40NT
COUNTER
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REVIEW
TAMARA
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SUPERVISOR
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