HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAli APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O
Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: L��
PROPOSED IMPROVEMENT LOCATION:
Address:i Y i4I�
���� _ Lot No.
Property Tax ID #: ,9
e Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
iu
New Electrical Meter
Second Electrical Meter'
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: $ utilities: _Sewer _Septic Building Height:
Name f
Address:_ 13 5 �Jr0C Y'5yvn' kVX
City: f f State: 4�2-
Zip Code: �SCla�JS— Fax:- `���
Phone No. �- la -
E-Mail: 445 � f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: ci
Company:
Addres •
City: S�' state: —FL
L
Zip Code: - 142,10— Fax: -F� z-sv
e
Phone No - dl
E-Mail �tr
State or County 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
Name: - --
Address:
------
Address: State:
City:
Zip:_ Phone
FEE SIMPLE TITLE HOLDER:. Not Applicable
Name,_ —---
Address:
- — -
Address:
city:
MORTGAGE COMPANY:
Name:
Applicable
Address: state;
City:
Zip.. _ Phone:
„
BONDING COMPANY:
of Applicable
Name, ,
Address: --- —
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.
list uiPh an applicable Home Owners Associatlon rules, bylaws or and covenan#s that may restrict or prohibit sur.h
Str any restrictions W
. Lucie County makes no representation that is granting a permit will authorize the permit holder at build the subject prohibit
structure
which is in con
structure. Please consult with your Home owners Associatior; and review a ee thatdl will, eed in all respects, perform ithe work apply.ch may
In consideration of t=-ie granting of this requested permit, I do hereby g
in accordance with the approved plans, the Florida Building Codes and St, Lucie County Amendments.
a fullreview: room
rom un
rency
The following building permit applications are exempt ifn sceenrrrtions
ooms and acce story uses to another non add -residential use
accessory structures, siNimming pools, fences, wa , g twice for
WARNING TO OWNER: Your failure to Record a Notice �jf Commencement may result in paying ubiic records of St.
improvemen's to your property- A Notice of Commencement must be recorded in the p
Lucie County and posted an the labsite before the irecordintiog IpuroNot e of Commu intend to lencemnt. consult
with len r r a a orne fore commencln work
5igna re o Owner,l L ssee/Contractor as Ag or Owner
STATE OF FLORIDA
COUNTY OF f'
sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this L day of 202f by
Name of person aking statement. �
Personally Known ___._-__ OR Produced Identif cation t!
Type of identification
produced P__ ----
t�)igr�LUI I� "11 1UUE JANE MCL�w
Y
Notary Iubhc - StaJ�j
commission ion ii 2x'14Y Comm.Expires, 2024ded throulZh Nationay Assn. _._
REVIEWS' FRONT ZONING SUPERVISOR
COUNTER � REVIEW, I REVIEW —
RATE
RECiwi— E�----�'.�
DATE +
COMPLETED
signature of Contractor/License Holder
STATE OF FLORID -
COUNTY OF �
Swgrn to (or affirmed) and subscribed before me of
�/ ph sisal Presence or C)n{in2C�otabrization
this ^l day of _a�T���� --, y
nn r+F l a
Name of person making statement.
Personally Known --%Z— OR Produced Identification
Type of Identification
Produced
(Slgnaw1eY,��, JUCIE JtNEMCCAULEY
'�':
: Notary Public - state of Rg10Ai
Commission nissien ar HH 49-.
`•..,orn,:`` my Comm. Expires Oct 1, 2024
Ionded through Natianil Not — —
PLANS VEGETATION 51ATURTLE MANGROVE
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