HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Oil- — Permit Number:
Building Permit Application
Planning and Development Services
P�
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: 09/10- 6ccl-1--
PROPOSED IMPROVEMENT LOCATION:
Address: _ I% �f�7`ti 5�or4- 14�:Z`
Property Tax ID #: 309"7 ' 0190 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPT10 OF WORK
New Electrical Meter Second EI ctrical Meter (Affidavit required)
CONSTRUCTION INFORMATION, -- - - - — -
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: $ /0c.4 Utilities: _ Sewer _ Septic Building Height:
CONTRACTQE�
Name. �.�$�. e
Name: _ /`7
Company: ceiy
Address: os N S
_
City: State:&
Address:
City: �17 cl 4�,-4 State:
Zip Code: ��G�c� Fax:
Phone No. 3rq / - g3 73 E-
Zip Code: '53o G� Fax: —
Mail: /✓ & ye�475'e c,;Ww
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License g
from the Owner listed above)
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.
Name: _
Address:
City: _
Zip:
INEER:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_4Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: &Not Applicable
Name: _
Address:
City: _
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 commencine work or rerordinrr vnur Nntir•A of inmmAnrpmmnt
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
�jlOo�i�
COUNTY OF
Swor to or affirmed) and subscribed before me of
physical Presence or Online Notarization
this day of 20?2� by
Name of person making statemen .
v� NICHOLAS MI7700
Personally Known GOR Produced Identification
v
�p0. e�' Notary Public of Florida
State
`?° `: Commission q GG922464
Type of Identification Produced
Qr
?oF My Comm. Expires Oct 22, 2023
boo-:
Bonded through National NotaryAssn.
(Signature 4 Notary Public- State of Florida)
NICHOLAS M1TT00
r1� Y PU,,
° •� ��
Commission No. (Seal) ?�
Notary Public -State of Florida
k GG 922464
of
Commission
My Comm. Expires Oct 2023
�R ar Assn
Bonded through National NotAssn.
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