HomeMy WebLinkAboutBUILDING PERMIT APPLICATION Galt/I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
of
p ° 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:
L PROPOSED IMPROVEMENT LOCAT ON:
Address: 7-D/ _S . 7`�t t10-ii /ZJ_Vtr_ U 1-00-F 1 erca
Property Tax ID#: _�5_;>'71-- bDoA- o OD—(e
Site Plan Name:
Project Name:
New Electri
eter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Lot No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing — Sprinklers _ Generator 7 Roof /0, Pitch
Total Sq. Ft of Construction: �2 15 r_J Sq. Ft. of First Floor:
f
Cost of Construction: $ _ / (U �� �� Utilities: _ Sewer
_ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 971�� S, T- �� l ,P
Company: iTj
Address: ggpy���iesc ►r�✓1� (�tP
City: Qr) {7j QyCo State:12,
Zip Code: 3 Fax:
Phone No. E-
City: -?-.a W/ -& 45& State:
Zip Code: / Fax:
Phone N;o- .5 - Zk la-6
E-MailG(]GfiS
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License_ ,�_�,
1 uu a, - - a. ul 111-Y d Rcs-unuru imoxice OT Lommencement is required.
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:
Name: Name:
Address: Address:
City: State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: _ Phone:
_ Not Applicable
State:
Not Applicable
UVVIMtK/ GUN I KAL I UK 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 Ipnrip r nr an attnrnpv hpfnro rnmmonrinn %e —1, — --A;__ nI _.r
Sign o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF riAZQO'0�
Sworn to (or affirmed) and subscribed before me of J Physical Presence or Online Notarization
this l day of\1nr �t!�✓ 20�'L(by
'lQ
Name of person making Mtement.
Personally Known_ OR Produced Identification
Type of Identificati n Produced
(Signature of Notary P lic- State of Florida)
Commission No. (Seal)
p/ rL MARTA, SKOCZFK
_ ' , • `: Netary Rubiic - state of Fiar w
N `w-js Commission . GG 351624
My Comm. Expires Jul 4. 2423
lorde,e through national Notary Assn.
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