HomeMy WebLinkAboutBuilding PermitAll APPLICABLE l FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building.Permit Application
Planning and'DevelopmentServices
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:
PROPOSED IMPROVEMENT LOCATION:
Address: ��6 ��� t �n �-
Property Tax lD #: b a - ` C)CO " to Lot No.
Site Plan Name:
Project Name: l 1
DETAILED DESCRIPTION°OF WORK:
New Electrical Meter Second Electrical Meter,
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit– check all that apply:
/Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _Plumbing —Sprinklers
Total.Sq. Ft of Construction:
''II
Cost of Construction: $ 5 M� au
— Generator
Sq. Ft. of First'Floor:
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: rt6rn e-& a
Address: �l
Company I l-�hr�ryLh� ,4ir �+ Z`�►^�c–
city. _• State: �
Address:
�-1`� 5
Zip Code: �J/ Fax:
city: Stater_
Phone No. L4 Ln q — y ,50%
Zip Code: tl I Fax: g V'S_/ 4 q
E -Mail:
Phone No
•
Fill in fee simple Title Holder on next page (if different
E -Mail
from the Owner listed above)
State or ounty License, (! C5 nS
If value of construction is zsuu or more, a.Ktw-uxucu twul-C uwuw� +••_..�
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: Name:
Address: Address:
State: City: State:
City:
zip: Phone Zip: Phone:
rAddress:
E SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: �O Not Applicable
ame: Name:
Address:
City: 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
stlructure. Please consult with youcr Horne Owners Owners
ation and reviewrules,
your deed for any restrictions which maor
aprohibit such
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, wails, signs, screen rooms and accessory uses to another non-residentiaI 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 lobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature ssee/Contractor as Agent for Owner
Signa tractor/License Holder
STATE OF FLO D
STATE OF FLOC IJAL��
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COUNTY OFi ��_C
COUNTY OF C
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Notarization
Physical Presence or Online Notarization
✓ Physical Presence or Online
thiday of� �— 2t� by
this 3 day of _ iA I 202.6 by
��ca>7>o 2Gi
i i rYc.--
Name of person maki,
Name of person making tatement.
/statement.
Personally Known v OR Produced Identification
Personally Known '� OR Produced identification
Type of Identification
Type of Identification
Produced _
Produced
1-7
Sinature o. Notary . ublic t
Signature of Notary Public- Stat
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mission No. �� ? Nota c -State of Florida
Commission No.
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