HomeMy WebLinkAboutCox PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 506Cb F4. Plo-ce
Property Tax ID #: - sot> - O4-? S - C>C)C>• a"k.
Site Plan Name: boIN7-r_iLSot> C-,-
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical ✓Gas Tank ✓ Gas Piping _ Shutters
— Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ `Z�qb• 00... --
(Affidavit required)
Generator
Sq. Ft. of First Floor:
V
Lot No. (-P
Block No_
Windows/Doors Pond
Roof Pitch
Utilities: T Sewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
`
Name 'P'YYw'S '*' t-1�-I>P% 0C)\I•
Name:
Address: 1844 _ 6\V►n01\a L_,P^Q.•
Company: '9�P-U-4ft bppC m% i.�r� ufZlOc �I�s
City: U) �3(9- State:--TC..
Zip Code: �90d�`� Fax:
Phone No. E-
Address: 41bp 6,E !✓- i�l.t2 C'IJ
City: :�4tA.V%.R-c Statelz�+(_
Zip Code: 3 °IR_) Fax:
Phone No 1-7')• o'�-'01� a (.,LU
E-Mail
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County License c
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
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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.
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 OWN . Yo failure to Record a Notice of Commencement may result in paying twice for
improvements o your rap V. A Notice of Commencement must be recorded in the public records of St.
Lucie County d poste o the jobsite efore the first inspection. If you intend to obtain financing, consult
with lender o an atto of re com encin work or recordin our Notice of Commencement.
Signature of Owner*/E-' sS' /Co act T as ent for Owner
STATE OF FLORIDA
COUNTY OF 111f� da►�Ct rr�
Sworn to (or affirmed) and subscribed before me of " Physical Presence or Online Notarization
this X day of 20�( by
Name of person making statement.
Personally Known OR Produced Identification `e�A STo /v �Y///
Type of Identifical
(Signature of Notary - tate of Florida)
Commission No. (—A o!R6% (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
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SUPERVISOR PLANS I VEGETATION � SEREV RILE � M � WVE
REVIEW REVIEW REVIEW