HomeMy WebLinkAboutBuilding permit appAll APPLICABLE
Date: 10 1 01b I
ii
NFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) -1 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential Ix
I PROPOSED IMPROVEMENT LOCATION:
Address: bq qGo
Property Tax ID 41
Site Plan Name:
Project Name:
9 �.k ;I P!3 ..
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
�Mechanical _has Tank _Gas Piping _Shutters
Electric
Plumbing
--- Sprinklers
Total Sq. Ft of Construction:
host of Construction: $ 4PU--
OWNER/LESSEE:
Name f- --
ddr
city%0
Zip
Phone No.
mail.
Lot N o.
Block No.
Windows/Doors Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
Fiil in
fee
simple
Title Holder on next page cif different
from
the
Owner
listed above)
E-
CONTRACTOR:
N re:
Company. F
Address; 1a�4
its .ti
01
�N
C_�
-IJ
q-k�u %"') �- �
Zip Code: �-1��i �" Fax:
Phone No 'I '6 '1 � €�
E-Mail ba-cc-fb _1
State or County License Ct
If value
of
construction *Is
2500or more a RECORDED Noflce ofCommencement
Irequired.
f value
of
HAV *15 $7,500or
more, a E RDLI) notice of Commencement -is required,
i
State:
J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
C i ty; State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _Not Applicable
Name -
Address,:
City:State'
*P; _ Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
c1tv,
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.
t. Lucie h ��hconflicts r�Countymakes no r re5entation that i rantl . a permit ill authorize the permit holder to build the subject structure
with any applicable Homeowners A5sociatNfon rules, bylaws or and covenants that a 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, it, 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. Lucre County Amendments.
The following building rmit applications are exempt from undergoing a full concurrrenc review: room additions,
accessory structures swimming cols, fences, galls., signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER-0 Your failure to Record a Notice of Commencement may result in paying twice forI.
' ^
improvements to your property. A Notice of Commencement must be recorded in the public records vt 5t.
Lurie C my and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
withI der ar an attorne before commencing work or recording Notice ❑f Ct.ommencemen
Signature of owner/ Lessee/Contra
STATE OF FLORIDA
COUNTY OF /YZ r
as Agent for Owner
Sworn to jar affirmed) and subscribed before me of
this day of 120 by
L vo,)
r�
Name of person making statement.
Personally Known OR Produced Id ntifi atl n
Type o tificati sk&PAROURST -
i*L4A�r-wra of 20, 2,D24
(Sign
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev
FRONT
COUNTER
11111111 1111 lam
(Seal)
ZONING
REVIEW
SUPERVISOR
REVIEW
Physical Presence or
VEGF
RSV