HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
t ` al [ F` 7 77L__ 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: ,,ryry
Address:
Property Tax ID #: -�! _ �} 1'1"_ _ _ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION: I
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: Sq. Ft. of First Floor:
Cost of Construction:$ '���I���' Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACT R:
Name 15f6k,
Name: UM/nv ' - C
Address: 5 tit+ {i dP
Company: C r0 SiC' U►FirlA+'1
Address:`�I
City: A 9 FL State:
Zip Code: Fax:
City: State:
Phone No. 77J W3 '3S E-
Zip Code: _'3 'M 3 Fax:
Phone No 77 1 370 7/
E-Mail QiF �[� Gi ►+ : �� IAn
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License 17
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERNGliNEER: Not Applicable MORTGAGE COMPANY- _ Not Applicable
Name: r I[Yi. O rrn ' �,n r ✓,2L 6 Name:
Address: L c.M-1 !n Address:
City: u t r 0State: City: State:
Zip: Phone G - 3` Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip:,
Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
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
%an+lk leNneic,r eir ari atinrnav b%nfnrra rnmmanrino wnrk nr rprording vnur Notice of Commencement.
Signature of O'W' 6erf Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF T--f-�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this iJ_day of 201,lby ,rye A-&,:r-0 (zo 5 5 <n
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
Ke rry A. S i sso n
_
(Signature of NotaryPublic- State of Florida)
Notary Public State of Florida
Commission No. (Seal) Kerry A Sisson
My Commission GG 950211
ain Expires 01/22/2024
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Kev _51LW 11.