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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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.
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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