HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
SCLC ? ALL
Lam:-11_ti`"�f' -
r L c ', L c' rti - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 237-0
0
Property Tax ID #: Lot No. `T
Site Plan Name: aa,, .-u— Block No. 4 _
Project Name: ='A �T�kk ®mil C G.I -4Q c 6-t�
DETAILED DESCRIPTION OF WORK:
UtAS cs.` C� (X v, I& .gvl -V, ®ids e, S-*_+ aJz G",
New Electrical Meter 90 Second Electrical Meter A (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ -4®®
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name �.�
Name: Ci, lYQ3
Address: B26
Company:
City: v Stater.
Zip Code:az Fax:
Phone No � ?�R, t1� E-
b®
Addre1ss:
City: t0IbVA- ���('t`r'
Zip Code: PB CJ—'I- Fax:
Phone N
E-Mail �.g�
State: It.
°
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
���+,,-r`��OY�
State or County License �- L� C!`cv �,i
iJ')33 97
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:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
UW IMtK/ LUN I KAL I UK 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 lender or arnattornev before commencing wnrk nr rPrnrrlina vniir Nntirdn of
igna ure e Con ctor as Agent for Owner
STATE OF FLO
COUNTY I
OF ry "--70L
Sworn tp (or affirmed) and subscribed before me of _),Z�hysical Presence or Online Notarization
this day %c
= of �•,-` ib- w` , 202/ by
Name of person making statement.
Personally Known ✓'/ OR Produced Identification
Type of Ide tification Pr uced
-iKi
ignature of Nota Public tate of Flo
ALICIA PHILLDFlorida
Commission No. 0 Notary Public - State(Seal)Commission
N HHMy
Comm. Expires AuBonded
through National N
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