HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
C, L
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:
Address: 710� � �� � A� G 1
Property Tax ID 4. { �) C:) (7 3 0--`1 Ot O — LA
Site Plan Name: A) L
Project Name:
DETAILED DESCRIPTION OF WORK:
_
New Electrical Meter ---
S
econd Electrical Meter —
CONSTRUCTION INFORMATION:
Etz C L
A
(Affidavit required)
Lot No. as
Block No. 2 1
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
Pitch
Total Sq. Ft of Construction: S D
Sq. Ft_ of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: /I
OWNER/LESSEE:
CONTRACTOR:
Name ,- c co p, LL-_C
Name: T Q
Address: Pn 1-W,9 0
Company: e u j
City: • - State:Q: 2_
Address: MS C
Zip Cade: 45���, 1, Fax:
City: L-)& -
Stater
Phone No. E-
Zip Coder 1 Fax:
Mail:_ _ _
Phone No�cI - �y
Fill in fee simple Title Holder on next page (if different
E-Mail c �,
State or County LicenseCC.(_
from the Owner listed above)
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 iNFORMAT[ON:
f
DESIGNER/ENGINEER- Not Applicable MORTGA COMPANY: _ Not Applicable
Name: Name:
Address: Address. j
City: State: City- State:
Zip: PhraRe Zip: Phone;
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Rhone: 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 an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please corm] 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
witlender or pV attQ11ney before commencing work or recording our Notice of Commencement
J _1V_ ZY
5ignatur f Co acC - or -Owner Builder as applicable
STATE OF FLORIDACOUNTY
DF 5 T I--UC t e-
Sworn to (or affirmed) and subscribed before me of
this 7dayofTf_�orvw�ZOao>;by
Physics! Presence or Online Notarization
Name of person makings ent.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Pu fic- State ofFlorida)
Commission No.