HomeMy WebLinkAboutPermit NumberPlanning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce F( 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C Z Permit Number:
Building Permit Application
Residential -X--
Address: /L r? W iP,r/f i� f�C� 7 1 %r1
Property Tax ID ff: 02 Lot No�
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
r�
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 Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _ - 1)J UU Utilities: —Sewer _Septic Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name
Name: 1
Address: y-741 dz"'z
Company: f �„ ��irc,I
City: J�= i, z -frx . ee State: L
Zip Code: -?y99'1 Fax:
Phone No. -7 7 -Z ' Zl �- JYZZ E-
Address:
P
City: i -f State:
Zip Code: Fax:
Phone No .7 Z` S 2 9 2 617
Mail:
Fill in fee simple Title Holder on next page {if different
from the Owner listed above)
E-Mail 4ic %o 61,4 C
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State or County License/ D
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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: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
j Zip: Prone Zip: Phone:
FEE. SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
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 ggranting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable HomeownersAssociatlon 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 recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA J4,LX-4—e,
JCOUNTY OF
S(or affir d) a d subscribed before me of Physical Presence or Online Notarization
Zmtby
day of 2(Q I
Name of person making statement.
OR Produced Identifi ation � 1
Personal) Known
Type o d tifica on d d L
(Signature o No u ic- State of Florida)
Commission o. P ta�_A; ccrr a
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REVIEWS
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED
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