HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Io ! 1-11 0,11 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:
PROPOSED IMPROVEMENT LOCATION:
Address: G_r i-j-q
Property Tax ID #: 1 3 3 5 — fi o Z— 6 o 0 9—y_�. d Lot No.
Site Plan Name:
Project Name. Q� ti ��� 7) fZe-
DETAILED DESCRIPTION OF WORK:
Block No.
r. 1 �e t• L 1,e
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank —Gas Piping
k Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
2ao 0
Sprinklers
(Affidavit required)
Shutters _ Windows/Doors Pond
Generator Roof _ Pitch
Sq. Ft. of First Floor:
Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
Name See-
Address: 2.7 -)) P �tri'l Qei
City: i rc State: �
Zip Code: 39J 'y�- Fax:
Phone No. _ E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: C_ktrIrs�—
Company: /'1 1aJr,1CJ Co
Address: g1 L `2 6'1- ; PS to
City: �c -, - / ( e State: —L
Zip Code: 3 i2 [a_ Fax: 1-1-1 &Iv 4
Phone No 9oy 3Se 3 o Z c v
E-Mail
State or County License_ E� t,g,g2c>
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
City:
Zip:.
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY
Name: _
Address:
City:._
Zip:
Phone:
BONDING COMPANY
Name:
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 attorney before commencing work or recording your Notice of Commencement.
Signat 'of .0 ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA Cu
�COUNTY OF
Swor to r affirmed) a d ubscribed bef rg me of Physical Presence or Online Notarization
this��ay of 2a by
ehxl sC.l41-1rl
Name of person making statement.
Personally Known OR Produced Identification
Type of Icf"ification ProdyFecl
re of Notary Pdblic- State of F
Commission No. �haTAY
Commiffl * GG i6m
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COUNTER REVIEW
DATE
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