HomeMy WebLinkAboutBuilding Permit Application (2)s
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date:/�pa! aSCE C Permit Number:
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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:
Address:
Property Tax ID #: 3� � roli - %JQ - O'-i 17 —C'iC�O -a Lot No. 30
Site Plan Name: 2)52�1 I�c�c� Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:°
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit requiredr
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: CD0 9 G Sq. Ft. of First Floor: L�7 0
Cost of Construction: $ AD r`� -- Utilities: _ Sewer ► Septic Building Height: S
OWNER/LESSEE:, , ::. ,:
CONTRALTO .
Name
Name:
Company: So
Address: 5-5-po1
City: e lEM2 State: F.
Zip Code: Fax:
Phone No. ')f)Q - o°il (o -� (��
Address: /03�D u: ��e�F_
City: %4,-
Zip Code: 34gWQ
Phone No 91)- -
C'r �k- 109
State:-
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
cx ® om
State or County License CSC-
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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.
SUrPPLEMENTAL CONSTRUCTION Ll:EN:LAW INFORMATION
:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: s� �N Phone 999-
_ Not Applicable
w c S�
03
State: R,
-Orif2.
MORTGA COMPANY:
Name:14
Address: g-I US 1
_ Not Applicable
City: Qom-
Zip: ':kggs-a Phone: 91)a-
State: r
Qm- 031�-P
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
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 is in conflict with any applicable 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.
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"your Notice of Commencement.
Signa a of Owner/ Lessee/Contra as Agent for Owner
STATE OF FLO11T
COUNTY OFF
Sworn to (or affirmed) and subscribed before me of ✓
Physical Presence or Online Notarization
this 1 day of _ 20LL by
knc lln �AIC-d Cc 1r"
Name of person making st ent.
DEBORAHSTEVENS
Personally Known OR Produced Identification
O�vsYP(%
• •�' Commission#HH 154345
Type of Identification Produced
a Expires August 11,2025
NOF F1O41 'B°^dedilw Budget Notary Servlees
(Signature of Notary Public -,State -of Florida). .
11 II ot►R� Pie
Commission No. t7 / � (Seal) ••
DEBORAH STEVENS
Commissbn#HH154346
1e
Expires August 11, 2025
P0'�\"
BandedflwBudgetNotarySembes
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Rev 5/20121