HomeMy WebLinkAboutLOCKE PERMIT APPPlanning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �gl'o'J- Permit Number: II
Building Permit Application
Residential
Address: ='i c f'Ci ttiC'a iCJ4CC (;,t
Property Tax ID #: c� ; L-i Lf t e, a ) Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Zlectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ c> ,`-IOC' Utilities: _ Sewer _ Septic Building Height:
Name A, 1 t .- '
Name:_ �(7Are -
Companyr 1!ele
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E� c, i c'
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Address: ��t `�E, vk4Y) �� S4,
City. F C rl tyc'frr State: LLL
Addre�ss,,::., �
S' 3 nr)
Zip Code f; Fax:
City: ,fX f "i0
Stater_.
Phone No. i . i U0 . �z ,
Zip Code: JC C c'
Phone No < 377
Fax:
-
`°-1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Ma1f�0-n( o Ne Ii`F�C)C3f cvL�e
Otl(ill 6C try
State or County License }
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from the Owner listed above)
If value
of
construction is
2500 or more, a RECORDED Notice of Commencement is required.
If value
of
HAVC is $7,500
or more, a RECORDED Notice of Commencement is required.
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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 contlict 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.
Luc e Cpunty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wwh lender or an attornev before commencine work or recordine vour Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me of
thls�dayof �%� �I ,20� by
Name of person making statement.
Personally Known f ,.. OR Produced Identification
T.voe of Identification Produced
Notary Public- State
REVIEWS FRONT ZONING
COUNTER REVIEW
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Physical
Presence or _Online Notarization
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Sendre M. MNlon
MY Commission HH 1 t 5901
Expttes 04110=25_
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