HomeMy WebLinkAboutDougherty, Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
r., 7 '' : -:- 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) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
vQ.� �1 T Address: ni )tf�
Property Tax ID #: R�0�5 - r%�7=�R�'j -�I Lot No.�
Site Plan Name: Block No.�
Project Name:
DETAILED DESCRIPTION OF WORK:
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Q:�: W6 I- LO(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 Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
XElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
Name: 111 _
Company: �(- E�eL
Name
Address: �6
City: ��5� L-06.o- State:
Address:
City: State:
Zip Code: 344"5a Fax:
Phone No. 90 L_L(v-Tlcr..� E-
Zip Code: Fax:
Mail: lqq t
Phone No -7-
Fill in fee sim le Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License fCkDo/
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Vvv1YCI%/ i nmw_i VR mrriuvi i : 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 a sted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend r analtornev before commencing work nr rarnrrlina vniir nin+i,-o . f r'nY,-,.,-,+
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF S�• L
k
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thisk+►\ dayof rebruc,ry 20,14 by
Name of person making statement.
Personally Known 1Z OR Produced Identification
Type of Identification Produced
��-- '�2u��"�
(Signature of Notary Public- State of Florida)
Commission No. Wi IOCC361 (Seal)
Uvy Pubbc Shft of Flonds �P ,I GuGuy Rom BoudW
k1y COwvnission HH 109331
Expires 00MO25
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