HomeMy WebLinkAboutBUILDING 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 Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
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PERMIT APPLICATION FOR: ge. IzOo
PROPOSED IMPROVEMENT LOCATION:
Address: 32y0 Nakchex- 5- - Fork- FL S`i4g1
Property Tax ID#: 2H*Zq- 100/— 001 b— 000-3 Lot No. (b
Site Plan Name: Eyq&ge_ MOS- • Block No. Y
Project Name: I I /I
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical
_ Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ )—+, $QjQ. 00
_ Gas Piping
Sprinklers
_ Shutters _ Windows/Doors _ Pond
Generator ✓ Roof r7 / j 2 Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height: 90 1 Q
OWNER/LESSEE:
CONTRACTOR:
Name bLi4e17 H064
Name:
Address:'QHn WLi44er- 5
Company7005ctThC. 96kLA
9-onF" EY02✓�5�
City: h9K4- Pt d4'_C4 . State:
Zip Code: 3 L �) Fax:
Phone No. /V L A E-
Address:CC,;J'YQ 5E I_L1d 6/2i'
S-L
5-T
City: Ua r !�
Zip Code: 3NQ93 Fax:
Phone No
State: V:Z-
Mail: A�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ene_-k-aC
oQC"gaf'LsAeti<
State or County License (,CC 133
7-3`1 b
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:
DFSIGNER/ENGiNEER: _Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITTLE HOLDER: ^ Not Applicable
Name
BONDING COMPANY: _Not Applicable
me•
Address
City:
Zip: Phone
dress:
Phone.•
OWNER/ CONTRACTOR AFFIDVIT: Application is
I certify that no work or Installation has commenced prii
structure. Please consult wrtn your homeowners vssociamN
In consideration of the granting of this requested permit, I do
in accordance with the approved plans, the Florida Building ct
The following building permit applications are exempt frcwu
accessory structures, swimming pools, fences, walls, signs
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WARNING TO OWNER: Your failure to Record a Notid
improvements to you property_ A Notice of Co
Lucie County and d on the jobsite before t
with tender o a ornev before commencin
to obtain a permit to do the work and installation as Indicated.
nnce of a permit.
f aLthotize the permit holder to build the subject structure
taws or and covenants that may restrict or prohibit such
ew your deed for any restrictions which may apply.
I wI14 in all respects, perform the work
a full concurrency review: room additions,
s and accessory uses to another non-residential use
Commencement may result In paying twice for
kricement must be recorded in the Public records of St.
rat inspection. if you intend to obtain financing, consult
C or recordtn our Notice of Commencement
4Y
SIP -of contractor • or- Owner Builder as applicable
STATE OF FLOIi(D_Aa �M
COUNTY OF �� ��
sworn (or aM ed) and subscribed before me of
XPhysical Presence or Online Notarization
ibis f day ofI—..e./
�(Ce- LIZrc`
Name of person making statement.
\/01_0�
Personally ownORP edidentification
k:Type of n ficatlon�duce
gnatbre of Notary Pi" of orida)
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Commission No. GG 7QY30f (seal)
THERESAJAFFE
?° • ®l•, .r Notary Public -State of Florida
Commission A GG 202301
My Comm. Expires Apr 1, 2022
Bonded through National Notary Assn.
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