HomeMy WebLinkAboutpermit app - 7 madrid ln SLCAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ik/tic) 1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 00 f1OUA
Q
PROPOSED IMPROVEMENT LOCATION:
Address: cAk6 �_l
Property Tax ID
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CYO c'
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
`
XCMechanical _ Gas Tank —Gas Piping _ Shutters
Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $`]��
OWNER/LESSEE:
Name
Address:
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
City: L State:
Zip Code: _ ?��14 S Fax:
Phone No. E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: '
Company: )
Address: I—t 4 -411,3
—
City: Stater
Zip Code: Fax:
Phone No
E-Mail CC: �eel_LC-4,cnL
State or County License `-"j
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
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY: , Not Applicable
Name:
Address:
City: State:
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 lend rsw_a2 attorUgM4iefore commencing work or recording your Notice of Commencement.
1 ..__7
Signature of Own
Lessee/Contractor as Agent for Owner
STATE OF FLORA
COUNTY OF
Sworn t9 ` (or affirm d) and subscribed before me of �iPhysical Presence or Online Notarization
L this ay of v 20_-�, \ by
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Name of person making statement.
Personally Known OR Produced Identification
'f of Identification Produced
(Signature of
Commission No.
4;iY LESLIE R. ZELAYA
: M M' Not Igltc •State of Florida
Commission 0 NH 002558
`•.. orb;; ' My Comm, Expires Aug 6, 2024
aonded through National Notary Ann.
REVIEWS I FRONT ; ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER I REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE l
RECEIVED
DATE------- t ------
COMPLETED