HomeMy WebLinkAboutBldg Permit App_SignedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
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: Cc51,6 &-)fiCA 1 1—
PROPOSED IMPROVEMENT LOCATION:
Address: CTS M 6i(5 I a CI hX(f, P 1 tg+ GAG FL ygS2
Property Tax ID#: - 33 �2 1 P 805 ® OQ23 — MO — 3 Lot No.
Site Plan Name: Block No.
Project Name: � )kC6n
DETAILED DESCRIPTION OF WORK:
(Alt TC i .ej.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 Roof Pitch
Total Sq. Ft of Construction: 2 , Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name d• i
Name: h,
Address: ��DS 1` 61rSh TUOCZ
Company:
City: i- iA,. State:
Address: .
Zip Code: �— Fax: _
City: in5a io(a State:
Phone No. %�� — E-
Zip Code: �1503 Fax:
Mail: ►~1�copL Tm I- cor-1
Phone No — 47
Fill in fee simple Title Holder on next page (if different
E-Mail lohndM
from the Owner listed above)
State or County License CCc ( !s3
It 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: XNotApplicable BONDING COMPANY: 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.
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 tice of Commencement must be recorded in the public records of St.
Lucie County and posted on the job to before the first inspection. If you intend to obtain financing, consult
with lender or an attorney.44efore mmencing work or recording our Notice of Commencement.STATE OF (41 WO
I Signa ur of caner/ ct see/Contraor as Agent for Owner
COUNTY OFORIDA_--.a:rjnQ
!�]_
Sworn to (or affirmed)
and subscribed