HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 11-1 I ZI Permit Number:
(c JJ U ii, P � �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR: E1cC_+yjca)
PROPOSED IMPROVEMENT LOCATION:
Residential ✓
Address:----? 40 2 "
Property Tax ID 4: 1 31) 1 - U o 4 - 01 -1 1 - 0 0 0 - 0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
PKOe & vx i st,i�l-it..e.ol ?o ram,.' h Hu I oCGL�'10.+
New Electrical Meter Second Electrical Meter (Affidavit required)
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: $ 30C • --
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name SQ.so� Wasr_s
Name: Mic-hCt.e.,l Pr;1c
Address: 1401 PA
Company: Pndt E3.&4_+v;r4,1 S ✓ic % df r-L
City: $�+• F rn-cc State: FL-
Zip Code: 34AG I Fax:
Phone No. E-
Address: 0113 s lc -Ns ttwV
City: Fart- Pia'. State: P-
Zip Code: Fax: -7 7 Z - 4m 1 2 718
Phone No 0 b89y
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rh i 16-e @ 1' r c At. - e (c c4r' Col L 0✓
State or County License G L 130o SBS�I 2913 ��i
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 I MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Name:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
_Not Applicable
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 8rantin8 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 th jobsite before the first inspection. If you intend to obtain financing, consult
with IerreFaaattor bef Lmre commencing work or recording your Notice of Commencement.
AL� /�
Signs tur of Owner/ Less e/Co ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 5+. L1166
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or _ Online Notarization
this 17 day of 5!W tc.n 1vc. , 207.1 by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Q.I
(Signature of NoiNryPublic-StateofFlorida) g,,, CHRISTINA SAVAGE
F� ;Notary Public -State of Florida
Commission No. (Seal) y E Commission N GG 910736
` MV Commission Expires
Se tember 05, 2023
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Rev 5/20711