HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONNII MI-1'L{tiMVL 11T{ V ITIVJi VL VWIYII LLI LV { VI\ I'{I i-Li bl'i11 VIT 1 V YL M�.LLI ILA/
Date: Permit Number: 2-
LII L Ul U,-- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
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Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: '
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Second Electrical Meter
(Affidavit required)
New Electrical Meter ��
�C�ONSTRLJCTION INFORMATION:
Additional work to be performed under this permit— check all that apply: vMVY,I Vvv , — v y
f V Roof l Pitch
�L1.L lu _Sprinklers _Generator
1 c _Plumbing
�,q. ri, of rust rioUr:
i oral �q• rt ar l ons[ructiojn`� �� O� sewer —Septic Building Height: f
_
Cost of Construction: $ - Utilities: CONTRACTOR:
OWNER/LESSEE: Name:
Name Company:
I-1UU1 CD].
Addre s: „���. state:
City:
"Y'_Fax:
Zip Code: _ Zip Code:
Phone No. Phone No
E-Mailr�
E-Mail: if different License
Fill in fee simP
le Title Holder on next page ( �td1e or t.oumy
irarTl Lne
Vyyr►Br IlSieq aoove) fired.
e a RECORDEQ Notice of Commencement Is requlred.
e of construction is 2500 or more, a RECORDED Notice of Commencement is req
If valu VC is $71500 or mo I
If value of WA
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NGINEER: _ Not Applica
Name:
Address:
Uty: State
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Gty: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phonc
—Not Applicable
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
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in consideration of the granting of this requested permit, 1 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
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Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leader or an attornev before commencine work or recordine your Notice of Commencement.
Signatu
ctor as Agent for Owner
STATE OF FLORIDA,
<���+�
COUNTY OF
Sworn o (or affir d) ands b,cribed befo a me of ysical Presence or
this day of 20AI, by
Online Notarization
nt. ,``\,tttttfllflllll���1,
Name of person maki;��roduced
Personally Known Identification `��\` 1�T'•.�r'(�' i��
Type odu ed ` �,gtD,�?�tpW► S
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(Signature of Notary Public- State of Florida ] ! MiFl00"13
Commission No. lU (Seal)
,
IIIIiNH1N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
____