HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d -1 7- ,2 a
Permit Number;
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Building Permit Application
Planning and Development5ervices /
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:
Address: :22 aO cTe!'1TT n J�d Ff" A'i"-3t-de,
Property Tax ID #: -23 Z i, . �Q %� GDo J • DDd • 7
Site Plan Name:
Project Name:_
DETAILED DESCRIPTION OF WORK:
3YgZ/5
0 C wa f,—r h e r t'e 1- 112
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
—Mechanical _ Gas Tank — Gas Piping _ Shutters
Electric /Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 1 oZOQ
OWNER/LESSEE:
Name Wu//,ade COD e
Sq. Ft. of First Floor:
Lot No.
Block No.
e-
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
Address: oNRO 7eP17i (' 12
City: FState: �L-
Zip Code: 3W1 y5 Fax:
Phone No. 77-3- 979- 4/30 E-
ntail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:
Company: Fort Si Luce e PF
Address: d eic4e Dr
City: eor Sf Lurie State: FL
Zip Code, 3qi5Z _ Fax:
Phone No 7702 g65-65,:� q
E-Mail-po rf ulzie UM i n M 1. C.D
State or County License C FC 0 e Q; 5
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of 14AVC is $7,500 or more, a RECORDED Notice of Commencement its 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:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
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 an
Y 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
with lender or an attorney before commencine work or recording your Notice of CnmmPnr-Pmwnt
Signat r f er/ Les a/Contractor as Agent for Owner
STATE OF FLORIDA
51 LycI e
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
this :day of ��ib 20a by
Physical Presence or Online Notarization
i' 7a n e I !0
Name of p rson making statement.
Ir
Personally Known V OR Produced Identification
Type of Identification Produced
— L=A '6mal� ......
— 1 11 A" -_
(Signature of Notary P ic- State of Florida)
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