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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr13�" ©66'a ©00 Lot No. O( Block No. All L ALICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 01 Date: Permit Number: SCANNED 9`�� ��`��� � `���. BY 5t �Ucie County p 70 7- 0Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential VnL` 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG FVnding PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: fj Address: Property Tax ID #: Site Plan Name: Project Name: New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: Additional work to be performed under this permit— check all that apply: _Mechanical —Gas Tank I —Gas Piping _ Shutters _ Windows/Doors _ Pond _ Electric _ Plumbing, _Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: '� �10 - D Sq. Ft. of First Floor: I Lo Cost of Construction: $ - Utilities: —Sewer —Septic Building Height: I OWNER ESSEE: i CONTRACTOR: Name YAcu/ Name: Address: �aa LlOYAd A City: l' State: A-L_ Zip Code: 3 Fax: Phone No. % E- Company: Address: City: State: Zip Code: Fax: Phone No Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License 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. DESIGNER/ENGINEER: - Not Applicable MORTGAGE COMPANY:. _ Not -Applicable Name: I Name: Address: I Address: State: City: State: City: Zip: Phone: Zip: Phone I FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: Not Applicable Na me: Name: Address: I Address: City: I City: Zip: Phone: I 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 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrictorpprohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which ma 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 Lmpt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, I alls, signs, screen rooms and accessory uses to another non-residential use "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT AWAY RESULT IN YOUR PAYING TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE [THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Sig atur o O ner/ Le e/Contractor as Agent for Owner I STATE OF FLORIDA s �I COUNTY OF I The forgoing instrument was acknowledged before me this _ day of 120 by V n CAM PAq\1 Gk�— Name of person making statement. Personally Known OR Produced identification Type of Identification Produced ` ' P`,, ELLE qL - .._._,.._ __° N V (Sig urE (}5t a sajldx3 uolsslwwoo ANI ` Com &54&Q4 o`JE9 uoissiiuwo oilcind Axel '� i ,4 0 NHOnVA 1\13-1-13 REVIEWS FRONT ZONING COUNTER REVIEW DATE RECEIVED DATE COMPLETED �Aftm -ommission # G' My Commission e October 22, Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of , 20_ by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced WIt - of Notary Public- State of Florida ) 3 is n No. (Seal) VE SUPERVIS REVIEWOR I REVIEW I PLANSV REVIEW EGETATION I SEA REVIEW LE I MREVIEW.—