HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0
151r a LL�uL
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) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
: RQPOSED;.I,MPROUEMEN7',-OCATIONf -
Hess: U V r
Property Tax ID #: 3q1 q-�� Lot No.
Site'Plan Name: CC Block No. -�
Project Name:
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 _ PoW.
— Electric — Plumbing — Sprinklers — Generator Ro
of Pitch
Total Sq. Ft of Construction: Sq. Ft. ofFirst Floor:
Cost of Construction: $ Utilities: Sewer Septic Building Height:
:OWNER/LESSEE 4
CONTRACTOR:
Name 4- V"Cdvl WQ I
Name:
Address: P
Company: �1 S � �`'
City: o! r Uts � Stater
Address:
Zip Code: Fax:
City: - Stater
Phone No. _ 'r E-
Zip Code: Fax -
Mail:
Phone No % r
Fill'in fee simple Title Holder on next page (if different
E-Mai Q9L V- &MLY
from the Owner listed above)
State or County License
If value of construction is 25W 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.
w
`SUPPL''EMIV NTAL CONSTRUCTION LIEN LAW'.I,NFORMATION: `
DESIGN ER/ENGI EER: _ Not Applicable
•
MORTGAGE COMPANY: _ N t Applicable
1, ,riw
Name: o
Name:
Addres • a
Address:
City: cr tat
City: State:
Zip: Phone -59go
Zip: Phone:
FEE SIMPLE TITLE HOLDER: t Applicable
BONDING COMPANY: t4ot Applicable
Name:
Name:
Address: 41111
Address:
City:
City
Zip: Phone:
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. Cgie 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 recordine vour Notice of Commencement.
• at a of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA\ I
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this IP day of —p !QA - . 20 A4 by
Name of person making d4tement.
Personally Known --'OR Produced Identification
Type of Identification Produced L_ b L_
* jF
VV
(Signature of Notary
�tiPRY PUei ELLEN VAUGHN
Commission No. _�=J%W)of Florida -Notary Public
COmmitAlon # GG 270079
coffirhistibn Expires
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