HomeMy WebLinkAboutBUIDING PERMIT APPLICATION ---
Dec 08 202 03:409M HP Fax page 2
PeanitNumber: ta
RECEIVED
Planning and Development Servi= 4u ��, P/eri-nitting
Building and Code Regulation Division Commercial Resi"P,
2300 Virginia Avenue,Fort Pierce FL 34982
PERM IT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Prcdect Name: Al- e- Block No.
MDETAILED DESCRIPTnIoN OF WORK:
New Electrical Meter Second Electricael Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Add=ition work to be performed under this permit-check all that apply:
echanical —GasTank —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:
OWNERAESSEE: CONTRACTOR:
Address: Name:,Z le-
State: Address: -5.er
Zip Code:
Phone No.!�9"�-2
State: eez
All APPLICABLE lNfO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Phone No 77X �e2-1
Fill In fee simple Title Holder on next page(If different E-Mail ezz S-b
hm the Owner listed above) State or County License—4?/OL-,4�9-0-Y e 01'f
ff value of uction Is 2SOO or more,a RECORDED Notice of Commencemem is�requh-ed. ;X-n
if value of HAVC is$7,5W or more,a RECORDED Notice af Commencement Is required.
�
'--
Dec 08 2021 03:40PM HP Fax page 3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City State:
Zip: Phone Zip: Phone.,
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 grantingg 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 wdh 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 1 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.
,f
-So
attire df Contractor-or-Owner Builder as applicable
STATE OF FLORID
COUNTY OF Swom to(or affir d)and subscribed before me of Physical Presence or Online Notarization
this_day of 20 Z[by
Name of person making statement /
Personatlgifnauip OR Produced Ida ti ►cation ✓
Type of Identifiratiori Produced ,��(� L41 17G7 F1 L —Y ✓e r
(Signature of Notary P �nt7o ti of Fjpda)
Commission No ?�IL(Seal) 'e ALEJANDRAIALLEGAS
(• NcfaryPdS'c-aatep Fc•4-
ssm=GG'S:B�%
., My CprR,Ezares oe:19.���
..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev