HomeMy WebLinkAboutHarrisBrentPermitPackAll 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
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
C
Residential
PROPOSED IMPROVEMENT LOCATION:
Address:U0_04Trso
Property Tax ID #: -
-
Lot No.��
Site Plan Name: rlswa Sa
Project Name:
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Block No 53 '
DETAILED DESCRIPTION OF WORK:
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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: $ g(ROO . 0c)— Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r
Name:
-t-
Address: L} 1 I
Company:
City: R)V- ltrc-cState:-
Zip Code: 34q Fax:
Phone No. E-
Addressk
City: State
Zip Code: Fax:
Phone No sq
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Fill in fee simple Atle Holder on next page (if different
from the Owner listed above)
E-Mail
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State or County License y�
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 our Notice of Commencement
Signature of Owner) essee/Contractor Agent for Owner
STATE OF FLOI�-r
CQUNTY OF L Cil�-
Swor/n,(or aff ed and ubscribed bef a me of Physical Presence or Online Notarization
thislV"'day o 2CU by
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Name of pe on ma`kinn statement.
Personally Known !1 OR Produced Identification�0�,��lilGlllli�!!!!!!
Type Identification Produced �MF z��i
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(Signature of Nota& Public- State of Florida)
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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