HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
s' L-u L L
r` 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:AL
PROPOSED IMPROVEMENT LOCATION:
Address: ;�> r- i f -- qc? F�2
Property Tax ID #: 34c a _ — Q
Site Plan Name:Z►-)DI1UI�j I i/�
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
(Affidavit required)
Lot No.—,-3
Block No.a
CONSTRUCTION INFORMATION: {
Additional work to be performed under this permit- check all that apply:
ti
a� Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 7, �2-._
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name IIDALVO
Name
Address: JqQGraf!
Company:
Address: '2cu,� 0 o� the �cr
City: Fbf-1 Stater(,
Zip Code: 54932- Fax:
Phone No. i 7Q,— 2.I (0 '01 01? E-
City:T'101 r }--- 6t State: `V-L-
Zip Code:3gg Fax:
Phone No 772---33-7--322---'
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rylary " ( 1
State or County License CAAC 1311704
Ivmuc u! wn5L1uctio11 is c:)uu or more, a 11MUKUtu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
°Name: _
Address:
City: —
Zip:
�' 1 9i
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City: _
Zip: Phone:
_Not Applicable
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/gd posted on the,,jobsite before the first inspection. If you intend to obtain financing, consult
with leerier r n attorprev bafi6re commencing work or recordine vour Notice of CommencPmPnt
e
Sig tore of Contractor dr - O t#r Builder as applicable
STATE OF F LO
COUNTY OF L � �
:2-
Sworn t Aor affirmed) and subscribed before me of ---"'—Physical Presence or Online Notarization
this clay of VnafM 2Qby
Name of person making statement.`
Personally Known OR P�duced Identification
Type �of(I}dentification Produced H-PL.
Y
(Signature of Notary Public- sta e of Florida)
Commission No_G(a 4a!R(ri jn Seal)
RBI .gip, , MELANIEENRIGHT
Notary Public - State of Florida
T , '' Commission # GG 285705
My Comm. Expires Dec 25, 2027
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