HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 7- 1 Z 1 21 Permit Number:
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LF 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: Elc�tri ca
PROPOSED IMPROVEMENT LOCATION:
Address: UZ CJ Z SGtndP;nt, CGi v' 34q5 2
Property Tax IDfi: 3'i2bLot No.
Site Plan Name: Block No.
Project Name: RDyve- Zec, I;4�r P.
DETAILED DESCRIPTION OF WORK:
InS-{-aI1 ae,w U
12 nun- rv-a f oorc r Aaeo -h A ttU
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: $ S Op Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name UY <_
Name: Mif_inttLl Pricle
Address: S G ii,
Company: Pri clt t-Acc tya C cl Sery "t )F'F
City: Pit_ State: Pt
Address: 843 S L-11-4c tj"
Zip Code: 34'01 SZ Fax:
City: FF+ . P i r./[ C State: tti
Phone No. E-
Zip Code: 344°14 S Fax:
Mail:
Phone No 7 I L S-1 D -cpOcAq
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rni1ce&Pridc.-tIcC_f-tcat -ror.
State or County License 157C. 1300 585'1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is 57,500 or more. a RECORDED Notice of Commencement is required.
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 TITLEHOLDER: _ 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 such
prohibit
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 gptb jobsite before the first inspection. If you intend to obtain financing, consult
with lender or a n befa re commencin work or recording our Notice of Commencement.
JS2 1
Sign#4 of Contractor - o - ner Builder as applicable
STATE OF FLORI
COUNTY OF � yr r
Sworn (or affirmed) and bscribed before me of Physical Presence or Online Notarization
_
this day of 209 by
� t
Name of person making statement.
Personally Known ✓ OR Produced Identification
Typyofydentification Produced
(Signature of Notary State of Florida)
/IPublic-
Commission No. W &105a (Seal) David Raymond Prue
NOTARY PUBLIC
STATE OF FLORIDA
Conergl GG287052
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