HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J Permit Number:
9r. [LUUC ER
o"
- - ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial '� Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
• Oi 1/ • • INS
Address: ],� y
Property Tax ID#: �� l a� ''" J �� f Lot No! i
Site Plan Name: Block No.
Project Name:
DWeA.I I ND 1 3 SARIPTI X NOF •
1)m (�,csi d-ailh aj stn , �G
b 4-9) A (4) aj--)d
New Electrical Meter Second Electrical Meter
MWSITIRU IONI IN IFORMTION:
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 _Roof Pitch
Total Sq. Ft of ConM$ /
Sq. Ft. of First Floor:
Cost of Constructi V i Utilities: _Sewer _Septic Building Height:
OWNS /LE�S�SEE: «ONTRACTOR:
Name
a.i
Addres C, .,>, ,+, ,^ Company:
City: ` State? Address: , t
Zip Coder _.. ... .Fax - -4;: a <. .. 5 City: `t asSttat ;""
kra
Phone No. 7r12) X32,`760 6 Zip Code:
E-Mail .� 7
`@ I 7, t ! Phone No '0
Fill-in fee simple Title Holder on next Oe4e(if different E-Mai
from the Owner listed above) 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.
SUPPLE TAL C4NSTRUCTtON L! N LAW N'FORMA f N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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 issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. ?
1n 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 fallowing 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 ins action. If you intend to obtain financing, consult
wit nder or an att•me before commencingwork or e ordin our Notice of CommenceMerit.
V
e of Owner]L see] ntractor as Agent for Owner S' nature of Contractor] ' ansa Holder
OF FLORIDA ATE OF FLORIDA
COUNTY OF ,1.� COUNTY OF �� +
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
P sical Presence or Online Notarization P ysical Present r Online Notarization
this day of 2020 by this aday of^ 2020 by
Name of person making statement. Name of person making,s/tatteemen
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced _ Produced
(Signatu (Sign ur + ary u o r� a
Commis SN MY COMMISSION N Gti Com MY COMMISSION GO 8226t e
weniber ON 15.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20