HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "x I Permit Number:
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: q° Q ran e O veriup_ 933 5. K ot.l- 9-
Property Tax ID#: s2 300 --' (— p 4,0
—
SMeYJa�e: j 0W n I CA
DETAILED DESCRIPTION OF WORK:
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
X Electric _ Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
;� 00'�- "-
(Affidavit required)
X
Block No.
Windows/Doors Pond
Roof Pitch
Sq. Ft, of First Floor:
Utilities. —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name - r 0 1 O ; kdhevd
C
Name: Zt L--'-
Address:
Company: q P C, bf . nc
City: j )ACt State: Fl—
Zip Code:._349 YS Fax:
Phone No. 7172 590 -O) D5 E-
Address: V20 -eA ? aVP_na.
City: P i eY" State: IL
Zip Code: 3qj 8 Z Fax: N,,4
Phone No
Mail: (it7� l�13 � �1 � � g0+00 - UY"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail re 5(.( fit . f:
State or ounty License C 13 0 Q 12 z q3
IT value of construction is z5uu 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:
Not Applicable
State:
BONDING COMPANY: A Not Applicable
Name: _
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 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 an attorney before commencing work or recording vour Notice of Commencement.
Sign re of Contractor - or - Owner Builder as applicable
4ATE
OF FLORIDA
COUNTY OF .St-
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
th�i-s day of JZ)4G 20�2 1 by
�_q_
Name of person making statement.
Personally Known _ Y OR Produced Identification
Type of Identification Produced
(Signature of N tary Public- State of Florida)
Commission No. (Seal) .,.
Nolary Public State of Florida
Randolph McDaniel
r
so, T
t 1y Commission GG 352355
Expires 09107/2023
4at.,
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