HomeMy WebLinkAboutPermit Application Dickson.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Development Services Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone. (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:. 1 in A ii
Property Tax ID #: _ (_ F _
Site Plan Name: f -
Project Name:
DETAILED DESCRIPTION OF WORK:
n D. U0 tea s {� �
a 2
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical
_ Electric
—Gas Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ /
OWNERAESSEE:
Name L
— Gas Piping
Sprinklers
Shutters
— Generator
Sq. Ft. of First Floor:
Utilities
Address: -� 1 a �sdM De
City: /"6-F State:
Zip Code: Fax:
Phone No. �D/,o - -'20e L/[� i E-
mail: v
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No. i
Block No.,.-
/� la �5 1
oZ kC'.SL bi b�s .
Windows/Doors Pond
Roof Pitch
Sewer _ Septic Building Height:
CONTRACTOR:
Name:
Company: Ei R S 1 04ai ct=
Address: / - S T
City [moo j t , t ( Z ( State:
Zip Code: 3_ q 9S11 _ Fax:
Phone No rf -J a - Ll
E-Mail �[G�O/ rr�
State or County License 4��
1)�I q
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:
Name:
Address:
Name:
City:
State:
Address:
City: �-
Zip: Phone
Zip: phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Name:
Address:
Name:
City:
Address:
Zip: Phone:
City:
Zip: Phone:
Not Applica
State:
—Nat Applica_ble
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indica Led.
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 OWN ur failure -to Record a Notice of Commencement may result in paying twice for
improvements to your p owce of Commencement must be recorded in the public records of St.
L ie County and pasted an before the first inspection. if you intend to obtain financing, consult
wit der ran
attorne efore�ca encin wank or recordin our Notice of Commencement.
of Owner/ Less Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
or arnrmea ubscribed before me
this 2 - day Of -6.e4Q yyh e f . 20�j by
Name of person making statement.
Personally Known X OR Produced Identification
Type of I01�ntification Produced
Notary Public -State of Florida)
Commission No. W11W
(Seal)
REVIEWS FRONT
COUNTER
TE
DATE
COMPLETED
ZONING
REVIEW
Physical Presence or Online Notarization
aIVamry Pubdc Stale of Florida
Lynda A HadleyMY Commium GG 284432
Expires 1211=022
SUPERVISOR I PLANS I VEGETATION I SEA TURTLE I MANGROVE
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