HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
LLUGU
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: 1 - — Pr -Of
Property Tax ID #:
-T��1�LVY,
orct CL � a
Lot No. G
Site Plan Name: Block No. 4:5
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: I q Q
_Generator Roof q I ( 2—_ Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ G 1 rt Utilities: _ Sewer _ Septic Building Height:
Name SGn—fui --rr—Vr► r) bra _
Name: G. %
Address:'5 C.P -T7o lrP_,Q.rS (q 5C:W�
City, T ('mot-eiCQ_ State:-
Company: aAc 2 U L► A C4 � C_
Address:SlQL `v
Zip Code: 2 - c�2Fax: _
Phone No, E-
City: X " 'zrA ifVryWCJI , ii State L
Zip Code: Dq 01 _i 2 Fax: J
Phone No '�� �� (— 2 4SCI
E-Mail
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C-C (J52) ( Gl
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.
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
'I.1"; 1
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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
with IPnrier nr an attornev before commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA—
COUNTY OF
• .ryM ^�`
Sworn to (or affirms I) and ubscribed before me of Physical Presence or Online Notarization
this 1 day of • �� 201 by
clUar'�20
Name of perso aking ent.
Personally Kno n R Produced Id tification
Type of Identif_LZ
i tion Pr du ed LL 1On
(Signat N t . State of Florida)
Commission No. (Seal) S: oW_ Kenny Hanzow
cF Notary Public
-'State of Florida
Comm# HH087667
si 1
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Rev 5/ZU/Z1