HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number"
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° Building Permit Application
Planning and Development Services
'Building and Code Regulation Division COOT tnerCial 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: 7 &I crk Alf-e- :Fo4 Prr r 3qa S 1
Property Tax ID #: 13 ()IO A A00D Lot No.
Site Plan Name: Block No. .
Project Name:
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 —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 3 OS . o� Utilities: —Sewer _Septic- Building Height:
OWNER/LESSEE: " ' ' "
CONTRACTOR:
Name L�ecnarl'a Pcdai�i'15: ':!
Name: m S ay+wz
Address: 143o0syLt�vP_ ' : - '
Company: JLTS� l}yk- LlL
Address: 541-4 NW Crrvrveu St
City: 7%4-4- vve.rre- I f State: R-r
Zip Code: 3491.51 Fax:
City: Puck- Sk State: V4—
Phone No. ' U%(o - Z.a4 - 9-7 q'L E-
Zip Code: SLURS o Fax: -
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail 1tr5�c�a�(l inn al+� m ho1-rna;L + �c�rn
from the Owner,listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requireu.
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: 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.
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
with lender or an attornev before commencine work or recording vour Notice of Commencement.
Signi ture of Ow er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF
Sworn to (or affvme and subscribed before me of
this.2.a- day of —V 2&-'O'by
Physical Presence or Online Notarization
Name of person r7rTking statement.
Personally Known OR Produced Identification.
Typ o dentification Produced
Si ure of Not Public- State of Florida)
; = W COMMISSION # GG 27W1. 0 iE
Commission No. (Seal)
'%•=•og;°.� �IRES.Dewmbw20,2i11'2
Bonded Thin Notary Publ c L'nCt4t'rr ::
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DATE
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DATE
COMPLETED
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