HomeMy WebLinkAboutBuilding Permit Application updatedDate:
Permit Number:
D
Planning and Develo I pment Services Building Permit Application
Building and Code Regulation Division Commercial Residential Xt,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
i PERMIT APPLICATION FOR:
P*
2--
Address:
Property Lot No.
Site Plan Name, Block No.
Project Name: TV,
DETAILED DESCRIPTION OV
WOW
New Electrical Meter rZ
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 Wfndows/Doors Pond
Electric Plumbing — Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction, Sq. Ft, of First Floor:
Cost of Construction: $ Utilities: —Sewer Building Height;
Name 1 W IT,
Address: A i1 1
Jll
city: va, a State:
Zip Code: Fax:
Phone No4 E_
Ma il�A n(J
Fill in fee simple Title Holder on next page (if different
from the Owner listed abovel
CONTRACTOR:
Name: Ll Icl rIL, VJ VV V_ if � -t r)
Company: MW If),stnll
Address: 7 0VIV_Vi
City: State:
Zip Code., 3 if"J, Fax:
Phone No 42a7 - IL4. 115
E- M a i I M Ij t 11 L-� lfga a xu 1 L-byr 1.
State or County License_ r�tS2-519 R
If value of construction is 2500 or more, a woRDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement Is, required.
R: Not
Name:
Address: I
City: State:
Zip: Phone
FEE SIMPLE T1 LE HOLDER, Not Applicable
Name:
Address:
City:
Zip: Phone:
!MORTGAGE CO PANY- Not Applicable
Name:
Address:_
City: State:
Zip; Phone:
BONDING COM A
Name:i*Y: Not Applicable
Address:
City,—
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 ranting a permit will authorize the permit holder to build the subject structure
which conflicts with any, applicable Homeowners .ociation 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 Count and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit nd or an aft-1;by himforp ing work or recording your Notice of Commencement.
L am,( /VjO7',� /,;? r5 -,;? ( -
34nai`uTe f Contractor - r - Owner Builder as applicable
.. !r3c"6 Z 0
STATE �F FLORID
COUNTY OF
Swo affix and sui;iscribed bqAi3rp me of XPhysical Presence or Online Notarization
thisay of by
4,—`1 21=
Name of person making statement,
Known OR
-(Signature of Notary Public- State of Florida)
M&
ComN mission oG47 q84 (seat)
y
S" S. Chlasso
ck—'10\ Notary Public
IL State of Florlds
" Commission Expires 0412MM4
Commission No. GG 982766
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