HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.
S L: Lll11L R
oU ..
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR: Re - Rv,C sh/r19/� 7w Alielal
PROPOSED IMPROVEMENT LOCATION:
Address: (D g03 PRasr TER. fbRr Sr
Property Tax ID #: 3W6- - 7=06 ' 00/��—
Site Plan Name: A/GLta1e1Oi-1a1C?O
.,
Project Name: L c
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No. / 3
Block No. /
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters -Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator -41 Roof VZ2 Pitch
Total Sq. Ft of Construction: 41300
Cost of Construction: $ Z&ff .t
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height: /2
OWNEMESSEE'
Name=A/77`/70/Y Ap10i16,
Address: m8L13 r-oZZ5I<7W-r'
city: pror/- St. L!/Ge State: FL
Zip Code:-4V4L52. Fax:
Phone No. bQ4?- 22.0-/9D5
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ,DU/lV- B. L4/"s
Company: TIPS NT/h9/7S
Address: T1W - A1�llc?��` sue•
City: sJWatU i4 State: A"L
Zip Code: 3i�j 1I Fax:
Phone No 772- 8-7Z- FL?30
State or County License CLG/ 332(�
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIpN:
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 roams 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 posw on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or a a ney before commencing work or recording our Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of �ysical Presence or _ Online Notarization
this _ day of 20_ by
Name of person making statement.
Personally Known W__1�011 Pro ed Identification
Type of Identi ' ation Produced
(Signature of Notary PP+aubl t t of Vricla )
FFE
Commission No. G"z a4iSd/ (Seal) t�pray.,, THERESAJAeof
1�;': Notary Public -Slate of Florida
is < Commisslon d GG 202ID1
orM1 My Comm. Expires Or 1, 2022
Bondld throutlh National NotifyAssn.
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