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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \....\,.-`I I @ B I B fi - i-- Planning and Development Serv.I¢es Build.ing and Code Regulatiorl Division Permit Number: Building Permit Application Commercial :/ Residential 2300 Vjrg.Inia Avenue, Fort Pierce FL 34992 Phone: (772)462-1553 Fax: (772)462-1578 CBDG Fundin8 site plan Name: ife Block No. Project Name: New Electrical Meter Second Electrical Meter (Affidavit required) coNSTRuerloN iNFORMATioN : i 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 Total Sci. Ft of Construction: Cost of Construction: S 00~© Sq. Ft. of First Floor: Utilities: Sewer _ Septic Building Height: OWNER/LESSEE:NTRACTOR: Fill in fee simple Title Holder on next page (if different from the Owner listed above) Company: Address: Zip Code: Phone No E-Mail State or County License If value of construction ls 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is $7,500 or more, a RECORDED Nctlce Of Commencement i§ required.. SuPPLEM£N TAL CONSTRUCTlo,N LIEN LAW IN FORMAT loN: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name:Name: Address:Add ress: \ i\ C,ty : state::ii?: pho#:\\ `\"!±=Zip: Phone I .\\ \ \\ \J, LEaEms:¥pLETITLEHOLDi`\+Nappiicabie ::mNe?'NG C°MPANY\ N HNo\Applicable Address: \ ' i Add ress: \ , C,ty:Ci. Zip: Phone:Zip: Phone: OWNER/ CONT RACTOR AFF lDVIT: Applic ation 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. i:PiLc#Cu¥:oe##as:Ir:5:a:i¥:a°£rRelhE5egs|e#a3tfa°:gt§#:i;Ss#sasn3ti|:%a3§e:#nTdttr,etvj|!a#o:r:g:n:d:i:f¥PSen:a#r!!t'a:iect#&s?##lt#!e##Rjt::#hure In consideration of the granting of this requested permit,I do hereby agree thinaccordancewiththeapprovedplans,theFloridaBuildingCodesandSt.Luciat I will, in all respects, perform the workeCountyAmendments. The following buil ding 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 CommencTWELEnpbete##vj]eoAbc##fbeeofnoo:Tf8ot#weTS?tt%r#pigt#dement may resulmustberecordion.IfyouintendingyourNoticete:3t!nao!i:e:ETf#:fn:jicnogr,dcso:fs:itofCommencement. ty -/\^- -.-; -±---1----=' ;- Signature of CoVIractor -o# -Owner Builder as applicable itAUTNE£FOFFLORIDL5h, i u a,`e :hYs°#(d°aryaofff'rT8tra,hdj&s1r-Afr. j¥e;z;ffifof rfhys,ca, presence or_on,,ne Notar,zat,on Name~of perso~nlmak.ing stat ent.PersonallyKnownRproduced Identification Type of ldentificatio Prod ced I/^ ,/._i--==-::---i:.---= _--:-==-i-_ _--= -i _± --i-a REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATERECEIVED DATECOMPIFTED ev 10/1Z/21