HomeMy WebLinkAboutCORRECTED APPLICATION FOR TEMP SVC- FPL POWER.pdfAll 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
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION
Address:- 3 k to QC H C�'-,
c i �
Property Tax ID #: 2-3 b a 00 c
Site Plan Name:
Project Name: U—�Yf�
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed
_,Mechanical
Electric
under this permit - check all that apply:
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ cilC�
OWNER/LESSEE:
Name 6
Address:
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
M
Lot No,
Block No.
(Affidavit required)
Windows/Doors _ Pond
— Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer — Septic
City: --1-TC leer .�
State: F�---
Zip Code: -3 3 3 3 j Fax:
Phone No. `� Se I - �'j b
E-
M a i l: CA rcL-�� g cam. (S � ,-� ( t
t n � c+. c
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: 1 -z' y,("e 5
Company:
Address: t�� (
City: � - ' I e e_ State: �C �-
Zip Code: Fax: -7 2 L(9'
Phone No -71 Z - -2-,-fi
E-Mail_j¢�v
cor'
State or County License {; ( 0-:F t/.
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 STRUCTION LIEN LAW INFORMATION:
D CON
E11GNER/ENGINEE11: Not Applicable
Name: —
Address:
City: State:
Zip: --. Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: ------_ Phone:
MORTGAGE COMPANY: Not Applicable
Name: —
Address:
City: State:
Zip: ._-___,_____ Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 and applicable with
your 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 Saying 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. with lender or an attorneybefore commencingwork or recording!f you intend to obtain financing, consultour Notice of Commencement.
x-
Si aT Vt ner/ Lessee ontractor as Agent for Owner
STATE OF FLORIDA i
COUNTY OF/z i
Sworn to (or affirmed) a d ubscribed before me of
this_j day of by _Physical Presence or Online Notarization
z/
Name of pe
Personally Known
Type of Identification
ingsent.
OR Produced Identification
Produced
(Signature of Notary Public- State of�Florida
Commission No. (Seal)
REVIEWS I FRONT I ZONING;
COUNTER REVIEW
DA
RE(
�n'vat CYNTHIAD.TilNlN6
MY COMMISSION # GG 3i377$4
" .0 EXPIRES: September 23, 2023
SUPERVISOR I PLANS I VEGETATION
REVIEW I REVIEW REVIEW
SEA TURTLE I MANGROVE
REVIEW REVIEW