HomeMy WebLinkAboutapplication]CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
c, LUCwt—
& Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address
Residential ✓
d✓
PropertyTaxlD#: 4l q-
Site Plan Name: �, �, ��, ���,� Lot No. —(a
-`��
Project Name: R2-A:1 Block No.
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
Mechanical VGas Tank V Gas Piping Shutters
Electric ` Plumbing , Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ qftt
OWNER/LESSEE:
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
— Roof Pitch
Utilities: —Sewer , Septic Building Height:
Name5, Gi`O-A'
Address: S '3 Sim
City: d State: V-L,
Zip Code: _. '�®„ Fax: —
Phone No. E
Mail:
Fill in fee simple Title Holder on next page (if different
frorn the Owner listed above)
CONTRACTOR:
Name: JA&0, DfLNC- b,4 j
Company: +SVIA S-
Addresss: wC3 S� �i�L4�[Zr
City:- "� A"(L+ State: t-
Zip Code: 401!1 -? Fax:
Phone No ��] �� G t9 Cl
E-Mail ' [�
State or'County License ' Z) Lk(�
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.
jPPLEMENTAL 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: Not Applicable
Name: Name:
Address: 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.
! 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
improvemeU4 to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie CounW a d post d on the jobsite before the first inspection. if you intend to obtain financing, consult
with lende or.An aqoropy before commencing work or recording our Notice of Commencement.
/
A
Signature of Co 4 attar - or - O e Bader as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to before
f/ Physical Presence Online
Notarization
(or affirmed) and subscribed me of
or
this � day of Gt' 20c� by
ement.
Name of person making��OR
a\��e G`�` • °,:5Si0N' °' • � /���i
��.••
Personally Known Produced Identification=
'vo���SJ{0ER
: � � '?���' '•
Type entification Prod ced
-- 9Go 908sai
(Signature of Not ublic- State of Florida)
`�i,�Qy•• pUbhc u,ae •'•��. ���
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_
COMPLETED