HomeMy WebLinkAboutPERMIT APP CONCRETE SLABAll APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
I Date: — J LA — - D_ Permit Number:
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I 101 r; Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential_
23DO Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462.1553 Fax: (772) 462-1578 CBDG Funding
Address: C 1--)'-
Property Tax ID k:
Site Plan Name: C
Project Name: C"
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
INFORMATION:
_ (Affidavit required)
Lot No.
Block No.
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: _
C'
rn�t of rnnOruction: S C1 , (`'(:X. Utilities: _ Sewer _ Septic
Building Height:
OWN R/LESSEE:
Name � \ L
CONTRACTOR:
Name: i
` C\V 6-n
Company:OCy SdCS
L( SCi i Y1 FLCity:i�(�
Address �` \ I
Address:
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QC�
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Code: _24,=J 'K Fax:
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city: �(Xf1l_1 f'_
Zip Code: �Fax:Mail:�r
PhoneNoI" 33
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_Zip
_ State: LL-Phone
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E-Mail . FLt r w
s e C Nfrom
in fee simple Title Holder on next page (if different
the owner listed above)
State or Cou
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If value of construction is Z5uu or more, a ncs.vnvcv ..v....c .,, ..................._... ._ .
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUP MENTALCONSTRYCTION
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: _Not Applicable
Name:
Name:
Address:
Addresss:
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 will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners Association rul s, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association ande 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
with lender or an attorneybefore commencingwork or recordingour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
O NtTMTCaFk42RfPP STATE OF VIRGINIA
COUNTY
Sworn to (or affirmed) and subscribed before me of _ Physical Presence or _� Online Notarization
this 2dtg day of 20Z2- by
Name of person making statement. ,,,,• ,,,
Personally Known OR Produced Identification '�Y *:"1 ,� ••°^^'�,'°°.""""°
Type of Identification roduced FL nI ('SR4-597-FIR-117-47) ,,,, couxn+axwo
11 wW A N!
(Signature of Notary Public-�"WX STATE OF VIRGINIA
Commission No. --9117a4_ (Seal)
REVIEWS FRONT` ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
Notarized online using audio -video communication