HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONC', \A - l ii
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
giro we
p Building Permit Application
Planning and Development Services Residential
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: C (ka"t� ,
PROPOSED IMPROVEMENT LOCATION: C
Address:
118, Lot No._
Property Tax ID #: f LI 3 - � , Block No.
Site Plan Name:L -&A
f e VVW-V S
Project Name:
DETAILED DESCRIPTION OF WORK:
� GI
ter
New Electrical Me
"� Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank �, Shutters windows/Doors Pond Gas Piping �
—
Electric lumbing Sprinklers
OWNERAESSEE:
Name S �C
Address:
City: State: !?u&
Zip Code: Fax: 2`a [-90
Phone No.
E-Mail:4X�'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Company: ✓� tY�vtlr Irvt
Address 11''rr5 LfCcY�t,�C'�i _
City: t State: f
Zip Code: L Fax:
L
Phone No
�I— `� z ��
E-Mail c`fS �' ►'GGv� �i' ��'r�
State o County License C-
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY:
Name:
Add ress:
City: State:
Zip: Phone
Not Applicable
Name: —
Address:
City: State:
Zip; Phone:
FEE —SIMPLE �TITLEHOLDER: Not Applicable BONDING COMPANY:
Name: Name:
Address:
T Not Applicable
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 bylaws Ihorrand covthe enants thadtemayto brestict or prohibitsuchect such re
which conflicts with any applicable Homeowners Association rules,
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
withlender or an attornev before commencing work or recording our Notice of Commencement.
5ignat f n r/ ess for as Agent for owner
ST TF OF FLORID
COUNTY OF '
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this _ day of 20Z1 by
L
Name of person mak(hg statement.
Personally Known OR Produced Identification
Type of Identification Produced
(SiEAattLre.Pf Nota Pub ic- SYate of FI rida)
•.JULIE
JANE MCCAULEYCo�1E.
410ta,^�
Duhlle - Statr ef�io )
My
Commission HH 49824
Comm. Expires Oct 7, 2024
Ionded through
National Notary MO.
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