HomeMy WebLinkAboutScan_0017.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Zq h:z—
Permit Number:
S5 L ` aL -�
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 I Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Cr
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
0
G CG rc,
(Affidavit required)
N
Lot No.
Block No.
_Mechanical Gas Tank — Gas Piping Shutters _ \l indows/Doors ` Pond
_ Electric Plumbing — Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
OWNERAESSEE:
Sq. Ft. of First Floor: II
Utilities: —Sewer _ Septic Building Height:
Address: _ 9 3o0 LAJorl
dCum Gt1c.�\1
City: Ar
_ POState: f-L
Zip code: `3 Fax:
Phone No. 1 - 1cj E-
Mail: UU i GZ t-pa rriocr.cot-)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: 3-0 S Q,
Company: ho i
Address: 9 3 5W
City: 9 lr S+ . L u c i e
Zip Code: 3 \-1 Fax:
Phone No -1-] - $ 1 q -
E-Mail
State or County License -
If value of construction is 2500 or more, a RECORDED Notice of Commenceme�required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is
State:
F' � •50 � S
State: Fes,
!L
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMA
DESIGNER/ENGINEER: Not Applicable 11Anf2Tr
Name: _
Address:
City:
Zip:
Phone.
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
ON:
COMPANY:
Name:
Address:
City:
Zip: Phone:
COMPANY:
Name:
Address:
City:
Zip: _ Phone:
— Not Applicable
State:
_ 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 ermit.
St. Lucie County makesnorepresentation that is ranting a permit will authoriz
which structure. Please cowithnsult applicable
your HomeownersAssociationanld review your d
In consideration of the granting of this requested permit, I do hereby agree tha
in accordance with the approved plans, the F orida Building Codes and St. Lucie
The following building permit applicati0 are exempt from undergoing a full cc
accessory structures, swimming pools ences, walls, signs, screen rooms and ac
WARNING TO OWNE • Your ilure to Record a Notice of Commence
improvements to your erty. A Notice of Commencement
Lucie County and post d on obsite before the first inspect
-with lender or an att me b fore mmencing work or record
;TATE
gna ure of Contractor- r - caner Builder as applicable
OF FLORIDA
`BOUNTY OF S e e
Sworn to med) and subscribed before me of- Physical
this 2a day of _� �i a r G,17= 20 Zzby
Name of person making statement.
l OR Produced Identification
on Produced
the permit holder to build the subject structure
d covenants that may restrict or prohibit such
red for any restrictions which may apply.
I will, in all respects, perform the work
:ounty Amendments.
icurrency review: room additions,
;essory uses to another non-residential use
nent may result in paying twice for
lust be recorded in the public records of St.
)n. If you intend to obtain financing, consult
ig your Notice of Commencement.
or Online Notarization
i7tgnato1ot P otar �Pt c- State of Florida) 61
Commission No. �1 Z 3�( ling
JENNIFER GRAY
--`�eal� Notary Public • State. of Florida
Commission # HH 223d02My Comm. i:xpires Feb 2, 2026
nded through National notary Assn.
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