HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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: 2 1 1A 00-11C. In i POY+ Gk- LU CAC- 34452.
Property Tax ID#: 3l 19 — F—>(:)I —00CIKII —C)Wr a Lot No.
Site Plan Name:-yo-OkA yl�oi e= Block No. 19
Project Name: Dom NDAe,=\A
[_DETAILED C3E5CRIPTION OF WORK; �����
0711010volt6kc
New Electrical Meter 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 Windows/Doors Pond
Electric —Plumbing Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (a2IN00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C>0—y i d j P—jon\rj Name: 6 1 P_f) U Q=i XCAD
Address: '2%k 03 Lf Company: 150AQV7
City: PDX \_ S)r- W42A e_ State:FLI Address: TO LA GQCAOte, 9-cl, (Ani-V A
Zip Code: &Aq�2 Fax: city:-rexypon !Spr'jnQC,- State: rL
Phone No. 77-7-2 • 919 '5S2(0 E- Zip Code: Fax:
Y-1�L
Mail: L4QO-il� to. R@jjMW t-Can Phone No (-QC)FL k
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Fill in fee simple Title Holder on next G- MBdiaDW i10
page(if different E-Mail
from the Owner listed above) State or County License Orc 51
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.
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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 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 our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF11"1�1kC;dS
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this_L_day of tDeM Oel' 20Z11 by
i
Name of person making statement.
Personally Known S OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida)
a°tVAY"puk,, EMILYY SOTO
Commission No. )
(Seal * Commission#002415703
e Expires August 6,2022
a'�or F�o�'� 6ondM Ih�u Budget NouryServlael
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