HomeMy WebLinkAboutApplicationAll 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 Ot
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCRTION:
Address:_ 520 3 5 IndlQti A'✓e.*' D2 wort Pre , ;cL 3y48',;;2_
Property Tax ID#: 3HO1-600 Off Dq— OHO - O Lot No. 3
Site Plan Name: QLA Pin \An M,yL2 is Block No.
Project Name: / i / /
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to,be performed under this permit -check all that apply:
Mechanical
_ Electric
_ Gas Tank
_ Plumbing
—Gas Piping
_ Sprinklers
Total Sq. Ft of Construction: I I D 0
Cost of Construction: $ q Jl 1100. Q 0
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
✓Roof 3It Pitch
Utilities: _Sewer Septic Building Height: CO "
OWNER/LESSEE:
CONTRACTOR:
Name
Name: 7D)i Ce
j-0. r-Q
Address: 5a.03 5 Inr/Qi1 JeWW 1'�,Y
Company:-XV.S ` -VAe
He4a./ Roof �Yo�i5:9r
City: -r o r k Qi -e rCe State: -'L-
Zip Code: 3M'1rX Fax:
Phone No. $6y- q/ 0, - nPJ!F E-
Address:`-4 1 H 0 SE CVaa Afa S�
City: ._ucte4
Zip Code: 3gi;?&?9
Phone No q4a--$3;P--
State: FL
Fax:
F1030
Mail: OG►A7i�Se�Fk�wriia//Oo .�-{
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail i�
State or County License
D
CGC 13373 b
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.
LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
—NotApplicable
Name:
me•
OWNER/ CONTRACTOR AFFIDVIT: Apprition 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 grant( a permit w111 authorize the permit holder to build the wbject structure
which conflicts with any applicable Homeowners Assoda�on rules, bylaws or;Td covenants that may restrict or prohibit such
structure. Pleaseconsu with your Homeowners Association andreviewyourdeedfor any restrictions which may apply.
In consideration of the granting of this requested Penn% I do hereby agree that 1 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 yo i ty. A Notice of Commencement must be recorded In the public records of St.
Lucie County an on the jobsite before the first inspection. If you intend to obtain financing, consult
with me before commencingwork or recordingour Notice of Commencement.
ev
SUPPLEMENTAL CONSTRUCTION LIEN
AddrCOUNTYOF ess: dress:
ure of Owner) Lessee/Contractor as Agent for Owner
STATE OF FLORIDA n-
Sworn to (or affirmed) and subscribed before me of r Physical Presence or_Oniine Notarization
th'ua9l=day of Ei, EP . 20 `L 6y
DJ 1 LE LA (t-4
Name of person makingstatement.
Personally Known _Y--, DR Produced 1deMlflcadon
yp ofldentiflcatiortPro
(Sign reofNoWry blic-5 taieofFlorida),„_..-;,,,,i,,Y_� _
% %•e `•,� tv'cary Pubic State of Florida
Commission NoO�(seal} '?�`H Mare A Moi!na
y._ MyCemm�sdo:GG27t082
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