HomeMy WebLinkAboutNicoleRummoPermitPackAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L CUL
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L LU b, ` f -" 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: mcr_ On
PROPOSED IMPROVEMENT LOCATION:
G Address: J' recd �r '
Property Tax ID #: _ — I CM Lot No.�
Site Plan Name: nl^� T Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
i �oe
New Electrical Meter Second
(Affidavit required)
I CONSTRUCTION INFORMATION: I
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: Sq. Ft. of First Floor:
Cost of Construction: $ r)_�00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONT
ACTOR:
Name
Address:
Name:
Compan
City: ir-i )P w Cr State: PL
Zip Code: Fax: _
Phone o. E-
Addre
City: State:
Zip Code: Fax:
Phone N 3�37
Mail.
Fill in fee simple Yitle Holder on next page (if different
from the Owner listed above)
E-Ma'
1
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If valna of 41Avr is t7 Snn nr mnra a RF:mRnFn RI^fira of rnmmanramanf ie ranuirad
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 consu t 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 commencine work or recordine vour Notice of Commencement_
Signature of Owner/ Lessee/Contract a Agent for Owner
STATE OF FLO r
A
COUNTY OF 1 ,
Sworn olor affirmed) and subscribed beMf a me of Physical Presence or Online Notarization
this day of S 20by
.
�r-�hl�ln l� �.►�-�
Name of pe on making statement.
Personally Known OR Produced Identification
Type of de of ation Pr ced
47/
(Signature of Notary Public- State of
C�IC�7� &13 dO T
Commission No. {_ eal k 11 A R m�
B L 16
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
i REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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