HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE OCABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: '►13(1� Permit Number: N� I ® lh
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Building.Permit Application
Planning and Development Services e
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION•
Address: ZUVV4 �—
Property Tax lD#: �� <''�`I�`l !i j'��L� �(?�S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED:.OESCRIPTION,OF WORK:
' �G
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
AdrMechanical
I work to be performed under this permit—check all that apply:
_Gas Tank _Gas Piping _Shutters _Windows/.Doors _Pond
_Electric _Plumbing — Sprinklers _Generator ^Roof Pitch.
Total.Sq.Ft of Construction: Sq.Ft.of First'Floor:qqcao
Cost of Construction:$ . Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONT. CTOR:
Name Name:
Addr s: Company: S
City: -State:L Addr s.
Zip Code:7*ANT5�-- Fax: City: State:
Phone No. Zip Code:7M{ k� Fax:
E-Mail: N Phone No
Fill in fee simple Title Holder on next page(if different E-Mail S ,
from the Owner listed above) State or Co my License Biz)
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: 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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cori ict 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.
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 attornev before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF l,l COUNTY OFF ,
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr ante or Online Notarization Physical Presence or Online Notarization
this 1 day of 20 2D by this 6 day of 20�0 by
,tyc, - t
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification'
Type of Identification Type of Identification
Produced Produced
(Signature.of Notary P lip State of Florida) (Signature of Notary Punllc-State of Florida)
Commission No. °'" LFISHAFIpyf)RAM-RANMtNG Comm" ion,'o , ._(Seat
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REVIEWS FRONT ZONI PLAidI ZWota > E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVI REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.!)/