HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /" 2 ` Z L _ Permit Number:
a 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: y L
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK: R
New Electrical Meter Second Electrical Meter__ -- (Affidavit required)
CONSTRUCTION INFORMATION:
^q
Lot No._
Block No.
Additional work to be performed under this permit -check all that apply:
Shutters Windows/Doors ,Pond
Mechanical GasTanlc �,GasPiping — ---
-Sprinklers Generator Roof Pitch
Electric _Plumbing — -J
Total Sq. Ft of Construction: Sq. R. of First Floor:
Cost of Construction: $ , � T -
Utilities: _Sewer ,_,.,Septic Building Height:-
OWNER/LESSEE:
City: (J ) State:
Zip Code: .C-7 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 1
�, i
Company:
Address:
5tate
City:: .
Zip Code: � 2_ Fax: � � -r'5 f Q
Phone No Z^ 3
E-Mail d GuJ
State or County License. C- 1 4
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 CONS TR,UCTION!�ILIEN LAIN INFOR'NIATI4N '
ER- _-L Not App
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address: State:
City: State: City:
Zip: Phone
Zip: r. Phone:
Ilcable BONDING COMPANY: Not Applicable
FEE SIMPLE TITLEHOLDER, _ANot App Name:
Name: Address:
Address: City:
City: Zip: r_. Phone•
Zip: Phone: •
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated,
l certify that no work or installation has commenced prior to the issuance of a permit.
5t. Lucie Counttyy makes no representation that is granting a A
ermit will authorize
by bylaws or the
covenants that mder to aydrestr{ct or proF prohibit such
which is in conflict with any applicable Home owners Association rules,
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this
plans, requested Florida landing Codes and 5t Lucie Cou�nity Amendments, in all respects, pe�arm the work
in accordance with the approved
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
lt in
WARNING TO OWNER: Your failure to Notide of�mying twice for
meCO ement must be recommencement may rded in the public records of St.
improvements to your property.
Lucie County and posted on the jobsite before the
work or rerst cord�inn� if you
Notice of Comtmencement. consult
with leader or an attorne before commencing
Signature o Owner/ Lessee/Contraciar as Agent for Owner
STATE OF FLORIDA
COUNTY OF��
or affirm nd subscribed before me of Physical Presence or Online Notarization
5wo to ( 1 2 by
this day of
Name of person making statemen
Personally Known t' OR Produced d if tion
Type of Ideoatf`f`t'o ea
�r nZ Notary Pub
a� suzette Ritchie
AA. commission GG
' - - (Seal)
Commission No.
PLANS GETATIREVIEWS FRONT ZONING SUPERVISOR R REVIEWV REVIEWON � VEWLE MREV EWVE
COUNTER REVIEW