HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-
Permit Number:
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: Jr y S-fc Se /VC4 e I Ro r f S f U C t e
Property Tax ID #: 3 q 19' 5 54. 66D 5 • DCaO ' o
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
11un hot wu er l`aa a verh ead
brfh roar 1K�.n�felc� b„e�,i n� 7�u�
aee :E le &8dle- S�OvVer Va
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
V&
Residential
L 34g83
M Water healet- fo-
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: $ 115 b 15.
OWNER/LESSEE:
Name Mary 6 0lZr
(Affidavit required)
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
Address: 2 D �vb cotliflo M i ra Monte
City: =f C $D r1 State: A7-
Zip Code: $ ,57"1 q Fax:
Phone No. 75`f %1l S� Jr ` C— E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:'Fort S Luri 2 u
Address: iff err f
City: _� a j uaie. State:
Zip Code: 3 -5°L Fax:
Phone No 7 7cZ Y68 -6 5a q
E-Mail r� u.C,� UM is1 Nil ,CO
State or County License C EC. 8 D o2 15
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:
Name: _
Address:
City:
Zip:
NEER: _._. Not Appli
Phone
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
Phone:
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: — Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
—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.
5t. 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 attorney before commencing work or record in out- Notice of Commencement.
4Signatrf erJ Le4e/Cont-ractorasAgentfor Owner
STATE OF FLORIDA
COUNTY OF S: Gl��l
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this a / day of 20-2a by
Name of ptrson making statement.
Personally Known Y OR Produced identification
Type of identification Produced
(Signature of Notary P1I1i/c- State of Florida)
Commission No. 603 6 DM (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
DATE
COMPLETED
sUPERVISREVIEWOR I REVIEW I PLANSV EVf WON I SEREV EWLE MANGRO
EEWVE