HomeMy WebLinkAboutBeekman changeout formAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
A o.
,r ...
e ft "" 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: r I .g
Property Tax lD #: Lot No.
Site Plan Name: r7 s Block No.
Project Name: .t' 1 f?i Irl AJ
DETAILED DESCRIPTION OF WORK:
L n u cn
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: Sq. Ft. of First Floor:
Cost of Construction: $ . L 50� Utilities:
OWNER/LESSEE:
Name V M 1 I I lr
City: r(
State:
Zip Code: Fax:
Phone No. - E-
Mail: I� �+
Fill in fee simple Title Holder on next pag d (if different
from the Owner listed above)
Sewer _ Septic Building Height:
CONTRACTOR:
Name:
Address:- 14`
City s State:
Zip Code: C JFax:
Phone No -L ) Z G 1 -7
E-Mail L. Q ri C,
State or Co ntv License
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
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone_
MA! RilCD►r-nwirnwerr.n wrr.,.,..�
--- -�••j ... - a HAL i Orin Hrriuvi 1. 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 hofder 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 accessary 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 our Notice of Commencement-
ig u e o �n,,lsse lContractorAgent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn for affirmed)and s bscribed bef r me of Physical Presence or Online Notarization
this day of 2oZTby
r
Name of person mWOR
tement.
Personal Known Produced' Identification
pe ntif" d
(9(gn (ure of No ary VD01i2FIMda
LINDSEY BAKER
Commission No. (Seal] Notary Public - State of Florida
of I , my Comm. Expires may 14, 2023
Bondeo through National Notary Assn..
ONT ZONING
REVIEWS ICONTER I REV( W 5 REVIEWOR REVIEW V EVEW�N REV EWES MREVIEWVE
DATE
RECEIVED
DATE
CO M PLEI-ED