HomeMy WebLinkAboutJacques permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �(1r ` �� ��� Permit Number:
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� �' � � L �� "�� ` � 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: � \��C�c�IC:��i�
PROPOSED IMPROVEMENT LOCATION:
Address: �� \\��0� ��� � �C-
Property Tax ID #: \�Q` -�� `��������� ^�
Site Plan Name:
n. ,.+ ni�.Y.�•
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 _Gas Tank _Gas Piping _Shutters
Electric Plumbing _Sprinklers _Generator
Lot No.
Block No. � � �
Windows/Doors _, Pond
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ������� Utilities: _Sewer _Septic
Roof Pitch
Building Height:
OWNER/'LESSEE:
CONTRACTOR:
Name�j�,\��L% )QC�ili
Name:�`L�+�'��C\. C � "`.\�C�E..\C\��'�
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Address:\ _- ��
Company: �S�'�'" �`i~` C-�C
Address:-..�. �'\ � \
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City:��� \��--'�° State:'\--
,���-i�� Fax: `_�
Zip Code• �°,
Phone No.���`���`ti-���, � E-
CityC��'� \ iC--\�
Zip Coder-�k�� _Fax:
Phone No `�``���- ������h��
State: -
Mail:���\�`� �\���� �C'\�'�C1E'��
E-Mail, `ia'� "����\'���\C-��C'�.-\��
State or County License ,� ���\
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Fill in fee simple Title Holder on next page {if different
from the Owner listed above)
IIf value of construction is z5oo or more, a KtI.CJKUCU wuu�c v� �.v��u��c��a.��.�..........-q.-••--• 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 MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_Nat Applicable
BONDING COMPANY:
Name:
Address:
Citv:
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.
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
�eiith.Lonrinr nr nn nttnrnav hafnrp rnmmanrina �ninrk nr rPcnrrlina vnur Notice of Commencement.
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ssee/Contractor as Agent for Owner
S OF FLORIDA
COUNTY OF ��' �;���,\�,
l
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
thisl��day ofC�C_�',��-eS��202..� by
Name of person making statement.
Personally Known OR Produced Identification
Ty f Identification Produced�C�C��c1�i�'l..�C:���-E
ignature of NotarjyP,u�b,l � State of Florida)
Commission No ���Y"�®� (Seal) E� � Notary Public Stete of Florida
Lisa M Catalano
� My Commission HH 146905
Expires Od/2t3l2025
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