HomeMy WebLinkAboutBuilding permit appAll APPLICf,BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �L 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
PERMIT APPLICATION FOR:—��UOCACL-CM- & G-rAra4i\)CO -
PROPOSED IMPROVEMENT LOCATION: 1111
Address:
Property Tax ID #:1�-T [�- i��Z-D(�?j%"�('� - 3 Lot No.
(
Site Plan Name: l hyi 5-1000g�+Ju. Block No.
1 Project Name
), C(Z�C'T�
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name"3
Name: J C CEKE� W AU-Sl-f"
Company: E 461"E JJyl LDE�
Address: ) K I INl�lflt`'IU N
Address: 'Z5-1 &j MAOW EY S-P -
,YA City: LLN State: fL,
Zip Code: �HcnQ Fax:
City:1�16r-7c State:�,
Phone No. E-
Zip Code: ��1 i Fax:
Mail:
Phone No 7" 1 Z.- ? Z-q
Fill in fee simple Title Holder on next page (if different
E-Mail(kLC.00
from the Owner listed above)
State or County Lic nse�
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:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Not Applicable
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 pos n bsite before the first inspection. If you intend to obtain financing, consult
with lender or an at me efore ornmencing work or recording our Notice of Commencement.
SI nature of Contractor -
OP P4; Notary Public State of Florida
STATE OF FLORIDA ?° Patrick A Romeo
My Commission 264001
COUNTY OF _ E.Pifes 22
OF
Sworn to (or affirme an su scribed befLorg me of
Physical Presence or Online Notarization
this 2u2clay of L '" _, 26�
Name of person making statement.
'-
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Notary Public State of %ride
Commission No. :° `� Patrick A Romeo
s , M GG 264001
xpires 1010112022
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Rev 10/12/21