HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `0 '�$ 20-L\ Permit Number:
S,!t. LuGa� -_ .
Aw"No
"` 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 LOCA N:
Address
Property Tax ID
Site Plan Name:
0
#:n Lot No.
_aIA VVNt - CGS Pr\/P _ C VC,60C, 1��11� �L�L� Block No. _A�
Project Name: —J� P C_)� �� L Ln LOT 13
'
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 _ Gas Tank _ Gas Piping _ Shutters X Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: C� . Ok Sq. Ft. of First Floor: . 0 ,
Cost of Construction:$_i�,��tJ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
'C \fNi
Name: J
FAddss. 1 L�•
QLL
Company: Ui(S1�lilAi�Ci InL•
�(� State
Zip Code: QI5a Fax:
Phone No. 772- (DIL 02RL E-
Address:
City: calI VC5lon State: TV
Zip Code: 0 Fax:
J'
Phone No i01 - %(n-�^ X2 -
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
......... -° - ------------
E-Mail Qt.I � A{ Va ry)c 4 �,_-)Lr t_OM
State or County License CRC �? 2a-j a2
- — •� ���•dole, d ncwnucu rvouce oT Lommencement 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:
Zip: Phone Zip: Phone: State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
_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 Commpncpmanr
44L `
Sig//ryBtuff of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOFrnirlo��
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of fi( r 2DAL by —
Name of person making statement.
Personally Known _X_ OR Produced Identification
Type of Identification Produced
Commission No.
:„a^M"0gc MORGAN DEBLOIS
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