HomeMy WebLinkAboutBuilding permit app, 100 RTU #1 AC replacement permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial ✓r Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Lot No.
Site Plan Name: Block No.
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Project Name:
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F I � PTION OF WORK:Sx��
New Electrical Meter Second Electrical Meter
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' ���1ORMATION
Additional work to be performed under this permit - check all that apply:
a�lechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors — Pond
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�y
Cost of Construction: $ f� _ Utilities: —Sewer —Septic Building Height:
..:r.: a, +
y
CONTRACTOR:
Name OJ 1 1 -D101 -_ � 11 ta.S
Name: h - /)'It( 1J 1
Company.
Address: b �h° V
State: ry
City: �' �-i vE�')1� St
Address: 1C,) �'Z ISE J1.
City: Stater.
U
Zip Code: �iy' Fax:�7Z 3 (f �� Z
Phone No.-7722 Ne �qw�,
Zip Code: �C �, Fax: 21? 120
E-Mail: �'j�A Ltrpyt-CJS'i,rie
PhoneNoi 'Z--023-12Z
Fill in fee simple Title Holder on next page ( if different
E-Mail rJ 1 C
State or ounty License l} (`I,-
from the Owner listed above)
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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7DES'rGNER/ENGINEER:Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
: 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
lI makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please coict nsult th w thpyoiurHle Home Owners ome Owners Association andiation rrev ewbylaws
your deed or any restrictions wh which may arestrict or l. prohibit such
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.
Sis f Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF `�3
Swofn to (or affirmed) and subscribed before me of
-./ Physical Presence or Online Notarization
this r day of 2020 by
Name of person making statement.
Personally Known �/ OR Produced Identification
Type of Identification
Produced
/License
STATE OF FLOI! f , f �,
COUNTY OF _T Lu
S V, to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _edaay of , 2020 by
Name of person making statement
Personally Known v"
Type of Identification
Produced
OR Produced Identification
. ! /. 2n
(Signature of Not/a/ry�Publilommission
Signature of Notary Publi
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NOW Y Pubk Stale of Rando
.� Notary Public State of FlorWa
Commission No.
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No.
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