HomeMy WebLinkAbout9408 Briarcliff TraceAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- & - Or1 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:
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PROPOSED IMPROVEMENT LOCATION:
Address:
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Property Tax ID #:
Site Plan
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
(Affidavit required)
Lot No. /
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 _ Roof Pitch
Total Sq. Ft of Construction: �]F I
Cost of Construction: $ r-A 1 � ✓�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
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Name: R i
:)Palo
In
Address: "1_(ly4l:p D6 a boyc
Company:
,71
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City: 1' L State: F1,.
Zip Code: � Fax:
Phone No. 177 r - 6Q
Address: -7
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City: 1 c
Zip Code: 314 JC
Phone No
3
State: Ft -
Fax:
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail o d
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State or County License k-
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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 INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City! State:
Zip: Phone
Address:
City State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF A-1AActe_
Sworn to (or affirmed) andisubscribed before me of Physical Presence or_ Online Notarization
thls �'�iay of 20 ZI by
Name of persorl making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
_
Commission No. 66 > 107 j (Seal)
�+`Y °c'••. BRENDA R. DECARA
if$ 1 Notary Public - State of Florida
7 Commission M GG 310775
nor
e;' My Comm. Expires Jul 1, 2023
Bonded through National Notary Assn.
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