HomeMy WebLinkAboutCozine PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:3 k 122- Permit Number:
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IF 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:
Lz'
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Z
PropertyTax ID M: 5q)-i - III - 6002_ - dm- 5 Lot No.
Site Plan Name(: y� Block No.
Project Name:\
DETAILED DESCRIPTION OF WORK:
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
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_Sprinklers _Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
1 U
Address: Il Q2%MAQ Ln
Company: O r1+
o
City:ycxi: Sr 1A'r�2. State:(
Zip Code: '?U06Z Fax:
Phone No. =772 .2U0 %( E-
Address: I -5 OE 15;Q_n Ed T#3
City:�n tSfne'C'r n Stateli
Zip Code:'!'A'iqS-i Fax:
PhoneNo7_2233S ql&A J
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail "
State or County Lic srtt,
It 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: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
UWNtK/ LUNTRACTOR 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 ranting a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable HomeownersgAssociaTion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu�t 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 attorneybefore commencingwork or recordina vour Notice of Commencement
S reofContractor-or- Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF 'M16iv 4 iY-\
Swoln to or affrmed) and subscribed be,�fpQre me of
�vtleyaf
`! Physical Presence or _Online Notarization
thi YV-CVCAI >X 202.by
Name of person making statement.
Personally Known f OR Produced Identification
Type of Identification Produced
gnature of Notary Public -State of Florida)
Commission No. ii eal) Notary Pubilc State or Flaride
Katherine Caldero
My Commission
IIII
HH 193049
Exp. 1128/2026
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