HomeMy WebLinkAboutAIl APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
` 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) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: o�T e
PropertyTax ID tl: — — OOCQ — Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
L
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: $ i� �; _ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: .Cn:T " 1
Company: p L�
Address: _ S1q QsQ r1e01CC4_d1t-t`P_ clo
Address: I
City: t State:,,,
City: pc'or s� 5z State:
Zip Code: Fax:
Phone No. — g0L4(D _ E-
Zip Code: Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail iw
State or County License UL cy:'q ?, W
from the Owner listed above)
f If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
CO;
Zip Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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,
to 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
improveme to your property. A Notice of Commencement must be recorded in the public records of St.
Lurpie Co y a posted on the jobsite before the first inspection. If you intend to obtain financing, consult
w fin er or a attorney before commencine work or recording vour Notice of Commencement.
4 r06', YAOYRAO TINEZGONZALEI
Notary Publk State of Florida
Sign ure o w Lessee/Contractor as Agent for Owner
-
�Yi Commissitsn r NN 374I0
F,
`
or M1 My Comm. Expires Aug 10, 2024
STA E OF FL RMICBonded
STA E OF FL RID
through National Notary Assn.
COU TY OF
Sworn o for affirmed and ubscri d before me of Physical Presence or Online Notarization
5 0
this day of 202L by
Name of person making statement.
Personally Known ,,<_ OR Produced Identification
Type of Identification Produced
{Signature of lztary Public- State of Florida}
Commission No. (Seal)
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