HomeMy WebLinkAboutSeafoam - revised applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f !
Permit Number:
U ding Permit AnnnCat;on
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding ____
New Electrical Meter �)( _ Second Electrical Meter
(Affidavit raniiirarll
Additional work to be performed under this permit -check all that apply;
Mechanical — Gas Tank — Gas Piping ` Shutters Windows/Doors Pond
tElectric — Plumbing — Sprinklers Generator
-.. Roof Pitch
Total Sq. Ft of Construction;
Sq. Ft. of First Floor:
Cost of Construction: $ 1426 0 Utilities: � Sewer � Septic Building Height:
Name
Name:
Address: Com an City: State; Address: 1J 7 Sul
r—
Zip Code: Fax: _ City: 1' 1 rff
Phone No. % % 2 - r >?
a E- Zip Code; � 0Fax:
Mail:
Phone No --
Fill in fee simple Title Holder on next page (if different - ail
from the Owner listed above)
S ate orounty icense
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.
ERANGINEER: Not Applicable MORTGAGE COMPANY: 0 Not Applicable
city: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Ap�lica`b_� 80_NDI�G COMPANY:
le Not Applicable
Zip: Phone: city:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a -permit to do the -work-
I certify that no work or installation has commenced prior to the issuance of a permit. and installation as indicated.
St. Lucie County makes no representation that is Rranting 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 consu t 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 attornev before commencing work ci�_ of Commencement.
Signature of wrier essee/Contractor as Agent �forowner
STATE OF FLORIDA
COUNTYOF
�
Sworno�
thisb= Physical Presence mr____Online Notarization
Name of person making statement.
Personally Known Ok Produced Identification
Type of Identification Produced
Expires OS/18=24
(Signature of Notary Public- State of Florida)
Commission No.
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