HomeMy WebLinkAboutScan_20220318.pdfAID APPLICABLE
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NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax I D #:
rt
0-
Lot No.
.
Site Phan Name: Black No.
Project Narne
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Miter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
1, Mechanical
Electric
GasTank
Plumbing
Total Sq. Ft of Construction
Cost of Construction: $ 1
OWNER/LESSEE:
Address: ► • - �
City: R_J M ` �A State: E.L
Zip Code: ' Fax:
Phone No..9 _3 2 -'b"^
Mail:
Gas Piping
Sprinklers
Shutters
Generator
Windows/Doors Pond
Roof
Sq, Ft. of First Floor:
Utilities: i Sewer � Septic Building Height: _
Fill in
fee
simple
Title Holder on next page cif different
from
the
owner
listed above)
E-
CONTRACTOR:
Company
Address:
City: `r?,� State: 1 �
Zip Code: `bLf\(A (D Fax:
Phone N o "I '-I 2 - ' `.110
E-Mail �S� L r� �
State or County License
Pitch
If value
of
construction is
2SOO or more., a RECORDED Notice of Commencement is required.
If value
of
HAVC i 7,500
or more., a RECORDED Not -ice of Commencement is required.
;;304 �-A i-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
Name:
Address:
City' State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City
Zip:
Phone:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address.
City. State:
Zip: Phone:
BONDING COMPANY:
Name.
Address:
city.
Zip:
Phone:
Not Applicable
WI C ER/ CONTRACTOR FFI D IT* 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.
t. Lucie County make5 no representation that is grantinga permit will authorize the permit bolder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
�
structure. Pleaconsult withyour I� or��rr� e r Association and rig our deed for an restrictions which may apply.
in consideration of the granting of this requested permit, l 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 full concurrenc review: room additionsf
accessory structures, s aim i rig 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.
Lurie County and posted on the jobs'ite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording Notice of Commencement.
Signature of Owners Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF Mips
Sworn to (or affirmed) and subscribed before me of
this �� day of I`� 2L3��ay
Name of p
Personally Known n Produced Identification
Type of Identification Produced 1 :J
(Signature of -Notary Public- State of Florida)
Commission No. (Se,��,
ti
Physical Presence or
EMMAPARKHuRsT
Commissbn # HH 055187
Wobar 20, 2024
oW Ttwu W*t Nary Senka
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEVI!
f
DATE
RECEIVED
DATE
COMPLETED
JL
Rev S/20/21
PLANS
tEVIEW
online Notarization