HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
pff404"# All, a., 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
� j
Address: 105 I- 6,-Lj � , V� Or- �J����
Property Tax ID #: -4
Site Plan Name:
Project Name:
el5- po_1
( DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors _ Pond
_ Electric _ Plumbing T Sprinklers _ Generator oof ± %Z Pitch
Total Sq. Ft of Construction: 33 Sq. Ft. of First Floor:
Cost of Construction: $ Ji •,5M,00 Utilities: —Sewer _Septic Building Height:
OWNER ESSEE:
CONTRACTOR:
Name � "'
Addres CD r L%i'.
Name: � �;
Company:
City State:,,.
Address:_ b''R Sf,, S JV 1e,P nP led"
City: ; fLL � State::
Zip Code: 3q952- Fax:
Zip Code: {5411�51-4-J Fax:
Phone No. q E33
E-Mail:
Phone No-T17421.(02-Lop
Fill in flee simple Tittle Holder on next page (if different
E-Mail QAJ,
from the Owner listed above)
State or County License
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:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: NotApplicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFRDVITApplication is hereby made to obtain a permit todothe 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 ! authorize the permit holder to build the subject structure
which is in conflict with any ipplicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure, Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
|nconsideration ofthe granting ofthis requested permit,|dnhereby a that | will, i 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,
acoessorystructunps,nmimnn|ngpoo|s,0ances,wmU4signs,acreenroomsandacnessoryusestomnnthernon-residenba|uwe
WARNING TO OWNER. Your failure to Record Notice ofCommencement may result in paying twice for
improvements to your property. A Notice of Commencement must berecorded inthe public records ofSt,
L and posted onthe 'obsitebefore the �rstinspection. |fyou intend toobtain �nancin8,consult
VV�h!�h��roramaNtornevbefore oornrnendnework qrrecording vourNotice ofCommencement.
STATE OF FLORIDA
STATE OF FLORIDA -Q
COUNTYOF
COUNTY OF
Sworn ffirmed) and subscribed before me of
Swor (oraffirmed) and subscribed before me of
ysical Pr--vqnce or Online Notarization
Ph sical Prq5gice or Online Notarization
Name of person miking statement �J
'Wa_meof'�p__erson making stateme
Personally Known OR P(ro Identification Z
own OR Produced Identification
Iced
f �Fa)
(Slgnatu�e of dot Public tte of Florida)
commission No,.()�Cia;%W (s2a",-.�rt
Commission No.
EVIEWS
NOW
WMIEE'
A70
SU
41
COMM
RE%P
E)W
REVIEW
REVIE
REVIEW
DATE
RECEIVED
DATE
COMPLETED