HomeMy WebLinkAboutimg028.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION T0 BE ACCEPTED
``._:`,+-i
F®RL
Planning and Development Services
Building and Code Regulation Division
Permit Number:
Building Permit Application
Commercial / Residential
2300 V.Irginia Averlue, Fclrt Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
Property Tax lD #:
Site Plan Name:
Lot NO.
Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTR I CTl,QN, INFORMATION,:
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank Gas piping
Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: S
Shutters Windows/Doors Pond
Ge ne rator Roof
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE:CONTRACTOR:
Address:
zipcode:3no`57 Fax:
Fill in fee simple Title Holder on ne}ct page (if different
from the Owner listed above)
Company,
Address:
Phone No ll
E-Mail
State or County License
If value of coristrLlctlon ls 2500 or more, a RECORDED Notice of Commencemertt ls requlred.
If value Of HAVC ls $7,500 or more, a RECORDED Notice Of Commericement i§ required.`
SUPPLEMENTAL CONSTRUCTION L[EN LAW IMF oRMA"oN:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Add ress: \ ^
Ej!E¥: phone \ rT`tate:!ii?: phoK: \\ `\\ tl5;--\ \ \\ \,
#aEms:rpL[TITLEHOLDN\iNappiicabie R:#e?'NG C°MPANY\ N HNo\Applicable
Address: \ - \Address: \,
City:City,
Zip: Phone: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 lssuance of a permit.
#iLc:{Cjc:oe#|ceTa±:Ir:i:a:i¥:a°£r#:lhFc;egs|eernia3tfa°:gtfit:i;S§%r§asngti|3giia8!e:[nTjj!r,ewgj|i;#;:o:r:g:n:d:!8f¥Psen:a:n;ttsr:t§#¥i:#i!diit#he&Fa#;h#t!#hure
ln 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 structilres, swimming pciols, fences, walls, signs, screen rooms and accessory uses to ancither non-residential use
WARNING TO OWNEFt. Your failure to Recoi.a a Notice of Commencement may result invvAr`iiNiivu I u uvvNt:r`: your Ta[iLITe TO itecora a Nolice oT I.ommencement may result in paylng twice Tor
[E#?EFefnyot?sn:donREnF#£beteit#REYj]eoAbcTgl|8#:f°ofr::hmemfi:±CFnT;en:t%::ifbyeoLejcn::dneddt:not!teajpnufp#.mmencingworkorrecordingyourNoticeofCommence
c records of St.ancing,consultment.
` :-`-..-..i -±-`--.::`--`
Signature of covIractor -of -Owner Builder as applicable
€TOAUTNE£FOFFLORIDtEL I uf!ie
:hyas:OaryL#jr#afa#,bs£¥m¥:Ojfca`,i-z#s'calpresenceor_onllneNotar|zat|on
Nameofpei§oiimT5Rrn5statement.
Personally Known roduced Identification
Type of Identification Pr ducethofREc+
tse„ :;j&i`;I+ fop:r::%;fri;:!£:sJOANTHAYEB
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
ev lu 12 21