HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //-) / 0 P
Date:
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Permit Number. 61 NeD
Building Permit Application st-?el
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION F0R:
PROPOSED IMPROVEMENT LOCATION:
Residential '�✓
Address: 7iGi�GI/Gh��G.4-5
PropertyTax ID #: y 0-9 d/ 4202,2 Lot No: -
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 'Z l 7 'L
Cost of Construction: $ % -]� 0(f> - =_
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Z 1'7 Z
Utilities: —Sewer _ Septic Building Height: r[_
OWNER/LESSEE:
CONTRACTOR:
Name 4'-19
Name: 141,e-�' e-��-
Address:
Company: &�r7 ��3 L L G
City: z/lPze-C State: F/
Zip Code: `i y B2 Fax:
Phone No. E-
Address: GJ �P/Cci SiFOr�i� `�
City: ��/� y� ��-��� State: r<<
Zip Code: b % g�. Fax:
Phone No _7 '7 Z z Z y ej t I p
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C"-yekS /�r
State or County License G CG i 3.) 2- d 7 37
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:
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State
Not Applicable
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 inst&llation 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 w :,ch 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 fLll ccncurrency review: roorr. aJw:{ions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and acc;?ss'c.:-y uses tuar;,ther:,o::-res:cential use
WARNING TO OWNER: Your failure to Record a Notice of Commerce, --.ant may r`suit:n dz—,,:ng .,,tii::a f.Dr
improvements to your property. A Notice of Comme.,ce:-ne^t Le ; i 2 i i1 :r:e ;)J� :c records of St.
Lucie County and posted on the jobsite before ire first ins; : L�;c. i" .. A rir.znc; g, consult
with lender or an attornev before commencing v.,)rk or
40-7
I
i
gnature of Contr ctor - or - Owner Builder as applicable
STATE OF FLORIDA
ICOUNTY OF
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SwoRgo (or affi d) an subscribed befprqq
this day of 2 1by
me of Physical Presence or C.;1 n,: Nc r at�cn
�P r� rn.,i1C3Z
Name of person making statement.
Personally Known OR Pro4eeed Identification
Type of Ide ification Pr uced
(Signature of Notary Public- Statt of Florida
PY F�j KAREN S. NIELSEN J
tir
Commission No. !Seal)
v'%
State of Florida -Notary Public
Commission # GG 207484
f`.•1y Commission Expires
` June 12, 2022
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