HomeMy WebLinkAboutseafoam circle panel change outAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J
Permit Number:
LF
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Budding Kermit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Commercial Residential
CBDG Funding
Property Tax ID #:
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Site • .Lot No.
Project Name: Block No.
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit —check all that apply;
Mechanical — Gas Tank Gas Piping p $ Shutters Windows/Doors Pond
�, Electric ._._Plumbing — Sprinklers Generator
-- Roof Pitch
Total Sq. Ft of Construction;
Sq. Ft. of First Floor:
Cost of construction: $ — Utilities: — Sewer — Septic Building Height:
Name
Address: Name:
• City: Address:)).2Company: ,, /}� i 5'TLt� Jrfrt !/ a
/ State: �— _..s_i 7 ��, Zip Cade: Fax:
city: . ill T Lid�'1
Phone No. _ State: J�
Mali:
E- Zip Code:.3. Ycl)? Fax:
Phone No --
Fill in fee simple Title Voider on next page (if different
from the Owner listed above)
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5 ate orr�o ntys lcense
If value of construction is 250ti 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.
Name: Not Applicable
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not
Name: Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
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. 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 lender or an attorne before commencingwork or recording your Notice of Commencement
Signature of wner/ Le see/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF f+
Sworn to (or affirmed) and subscribed befQre me of11
this �#day of i% Physical Presence or Online Notarization
._
20a l by
Name of person making statement.
Personally Known _ OR Produced Identification �Y;
Or'� Not" P ° of Fes°
Type of Identification Produced Kimia d. Smwe AAy Conm�sion GG 957803
Expires o53t6=24
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
DA
SUPERVISOR l PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
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