HomeMy WebLinkAboutimg019.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATloN TO BE ACCEPTED
Date:
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P E @ E; I B Lrtj --
Planning and Development Serv.Ices
Building and Code Regulation Division
Permit Number:
Building Permit Application
Commercial a/ Residential
2300 Vjrginjcl Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772}462-1578 CBDG Fundin8
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 8TES@ S ; Ofcfl/i ftyu LtQ Jj€ PH ro
property Tax iD #: 3E5 £f¥s--corer)q +-oo'rjLa Lot NO.
Site plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTloN l\NFO MATloN
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 Sq. Ft of Construction:
Cost of Construction: S
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:CONTRACTOR:
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 Notice Of Commencement i§ required..
SUPPLEMENTAL CONSTRUCTIJON LIEN LAW IN.F ORMATION: \ I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Add ress: \ A
City: State:City: \\ state:
Zip: Phone I .\zip: pho#:\\ \\.\\\ \ \\ \,L^
LEaEms:prpLETITLEHOLDqu\\+Nappiicabie Rg#e?'NG C°MPANY\ N HNo\Applicable
Address: \ ` 1 Address: \.
City:city: v
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.
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ln 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
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c records of St.ancing,consultment.
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Signature oi CoVIractor -oE -Owner Builder as applicable
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:hYg(d°aryaofff'!\(?2r\#£id!in##:cribed beforemeof rfphysical presenceor onlineNotarization4_-'J2:T%irbeT`/
Name of person makirfg stitemeirt. -
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLFTED
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