HomeMy WebLinkAboutseigler permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: _
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Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 'PYb6 --
Residential
PROPOSED IMPROVEMENT LOCATION:
Address; ill
yS
Property Tax ID #: ��`�Vc f f — 00 1 ?J ' 000 0 Lot No.� 3
Site Plan Name: V Block No.
Project Name: ��c I QUY
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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 XRoof b 112- Pitch
Total Sq. Ft of Construction: �� Sq. Ft. of First Floor: 2,3W
Cost of Construction: $ ZSI 500 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Addr
Name: 1401 Al
Company:
City: _� �' State: �
Zip Code: cz� Fax:
Phone No. E-
Address: Z5 f
City: VQ ,vp —RcCi On State: �L
Zip Code: `� 29 (_0 Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 1
State or County License f%
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 INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
Name: _
Address:
City: _
Zip:
Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
State:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 au applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consul 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 attornewbefore commencinia work or recordine vour Notice of Commencement.
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Swore (or affirmed) a subscribed before me of Physical Presence or Online Notarization
this day of _ 20 'ly
I
rha II(
Name of person making statement.
i
Personally Known OR Produced Identification
Iden ' ' uced
(Sign e f y Public- Sta lorida)
Commission No. Sea{ ppYPV"w KATHERINE.HAVENS
(Seal) "`�= MY COMMISSION #HH199309
EXPIRES: DEC 04, 2025
Bonded through 1 st State Insurance
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