HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a' y' �. Permit Number:
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,. 4 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-IS78 CBDG Funding
PERMIT APPLICATION FOR: E_-Je L.Y,' C 6-1
PROPOSED IMPROVEMENT LOCATION:
Address: 4�eldey- �_ano_L
Property Tax ID #: D LP ` t ? ) J & 0CDW _ 0 & 0 Lot No.
side-P-I-�+e: '3 5 _:YR NJ '%Z - L i S S N T. S f-T- tin D LESS L 9 D.I4 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
O F v D we a-- d v__� P-0 "e d i-,
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tanis _ Gas Piping _ Shutters _ Windows/Doors _ Pond
,Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
va
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height:
O W N S RAESS E E:
CONTRACTOR:
Name t. t�rM 1 ,"
Name: 5 eX7� �= )'� t d 1
Address ii (% 1 i P Wc ISk yea
Company: -e 'S C ) eC f`P ' L 0 ,, f, )
City: . State:
Zip Code: 3'-i 5 Fax:
Phone No. E-
Address: Z 0I,B �3 �I 1 n V•2.nUtg_
City: PCJr4- txt State: FL
Zip Code: -34 2, Fax:
Phone No �7 i �� • 3 (n
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
____..__
E-Mail D('_ S Lk 5oc
State or County License L C 13 U'0, 7a 03
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:
DESIGNER/ENGINEER:
Name:
X Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City. State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: X Not Applicable
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 attorney before commencing work or recording our Notice of Commencement.
�! _�_ _: - 7Z. W1_6_q Z 6 el � �- � z -
Signat of Co ractor - or - Owner Builder as applicable
S ATE 0 FLORIDt
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this�`l dayof F-2bn,eArA 20�� by
Name of person making statement.
Personally Known d` OR Produced Identification
Type of Identi`fica�tion Produced
17 _ I
(Signature of Notary Public- State of Florida
Commission No. O { al) ., NotaryPubkStateafFk)6,da
Randolph McDaniel
r , My commission GG 352355
of w# Expires 09/07120 33
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Rev 10 _L/_/Z1