HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO N9UST BE COPWIPLETED FOR APPLICATION h 0 BE ACCEPTED
Date: 0 15 PC'r: Et E': �:::':E'�.'
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I< � ,: c c' L - = Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
_
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624576 CBDG Fundin
PERMIT APPLICA T iON FOR:
YJ
PROPOSE)DI IMPROVEMENT LOCATION:
Address: i i LX� AS (\rZ �J� (l'
Property TaxID#: r-115-DUI--�r - j I_at No.
Site Plan Name: Block No.
Project Name: }C 1 41
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional worst to be performed under this permit —check all that apply:
.Mechanical — Gas Tank Gas Piping i Shutters—Windows/Doors Pond
Electric _Plumbing —Sprinklers `Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. offirst Floor:
Cost of Construction: $ S_'z" utilities: _ Sewer _ Septic BuRding Height:
OWNER LESSEE:
CONTRACTOR:
Name L
Name: , ( < r- n
Address• ��lV�
Zip Cade: - C r Fax: %(.
Phone No., %(� E-
Company:
GState:
Adc4ress:�
Eom
City: \ l S State: �-
Zip Cade: K Fax:J
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Phone No jig—C
Mail:.
Fall in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MaiuC (, (n ack
State or County license - c. / ;/�(��/ 0
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of HAVC is $7,5GO or more, a RECORDED Ncnice of Commer'.cement is required.
SUPPLER IEN AL CONSTRUCTION. LIEN LAW INFORMATION.
_.
DESIGf�FR EfiIGIi�IEER• Not Applicable pp ble
/ F -
MORTGAGE COMPANY: Not Applicable
Name: ,t J 5'�
Name:
Addre
Address:
City: t (, `, State: TL—
City: State:
Zip: Phone �(2`;"?
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPAPJV: _. Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 staying 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 attorney before commencing work or recording our Notice of Commencement.
24�
A IM
Si ture of Owner/ Lieess;q6&ntractor as Agent for Owner
STATE OF FLORIDA
ZA)
COUNTY OF -
Sworn t (or affirmed) arid s bscribed befSgjre me of Physical Presence or Online Notarization
this day of �ae ah e 2004 by
Name of person making statement.
Personally Known l/ OR Produced Identification
Type of Iden 'fication Produced
(Sig ature of Notary State of Florida)
'PJublic-
Commission No. ��f'1 (Seal) , NO1ary Pu� She of Florida
Kathleen O Rivera
E%00
o` My Commission HH 06OU2
Expires01/24/2025
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Rev 5120121