HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9114124 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: (16M S OLcan 17r. ,Te05en 5tach FL ?M57
Property Tax ID #: 4-502- W-0 -0014 -000 -S Lot No.
Site Plan Name: ��iili�i`'`�.� Cu�t�� Block No.
Project Name: I (A
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Gas Tank
✓Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
Sprinklers
_ Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ 11500100 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameWaile-5-�-?NL h VAaf et.t
Name: Lc) n'i - CLoy)ct twf)
Address: q( ,5 Cc00n Dr AW5
_
Company: Pl {l1 i
City: kt r)6en -Z' State: R-
Zip Code: 34W Fax:
Phone No. E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: L&L KE l(` )S�f la1 1b 1lC
City: To"�(l Cif State: 1
Zip Code: 3LPi67 Fax: 112-22-5 --0761
Phone No 172- 225-GW0
E-Mail Ii'1nuft,: ne mbu 'h h11 j"7k1(fCl r wn
State or County License RF110�i372 f 25
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:
Address:
City: State:
Zip: Phone
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 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 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 attornev before commencing work or rPrnrriinu vniir Nntirp nf rr,r,•,r,•,Anrorr,o„+
-
Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF i'1@M- n
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 1441 day of 20 2I by
Name of person making statement.
ZOR
Personally Known Produced Identification
Type of Identification Produced
(Signature of Notar4 Public- State of Florida)
�Q. �'
Commission No. � qQ (Seal) :�yO`-
Notary Public - S
Commissionli
ALYSSAMDNA
MY Comm. Expire
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