HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: n �
Permit Number:�lov ` ' l �
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: Kc +)
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..IRMIG.R Address:
Property Tax ID#:_ 1 I- CO ()\ Lot No.
Site Plan Name: Block No.
Project Name:
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New e ctrical.Meter Second Electrical Meter,
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Additional work tote performed underthis permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors `Pond
Electric ,Plumbing _Sprinklers _.Generator —Roof �(f Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ % U Utilities: _Sewer ,Septic Building Height:
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Name Name:
Address:�f 7J/ �r p/��j0 �.1� Company:
city: �4' P/ Qr-a-e- State: F/ Address:
Zip Code:�? M .r—( Fax: City: State:
Phone No.. (s S"'ti' Zip Code: Fax:
-
E-Mail: /kl •XGldf/�Cj p a,p/. 'dO ~" Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY. Not=Applicable.
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: —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 authorizethe permit 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.
In consideration of the granting of this requested permit, i do hereby agree that I 'will,in ail 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'Milure to Record a.Notice of Commencement may.result in.paying twice for
improvemerimto 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 irispection.'lfyou intend to obtain financing, consult
with lender-or an attorne' before commencing work or-recording ypqr.Noti6e`of Commencement.
k, n;Crt'ure of Owner/ ess ntractor as Agent for Owner Signature of Contractor/License-Holder .
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF- r (AA L COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before the of
Physical Presence or Online rization Physical Presence or Online Notarization
this 3 day of 2 by this _day of 20•.. by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known 'OR Produced Identification
Type of Identificatio Type of Identification
Produced V U(D , Produced
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(Signature of Notary Pub'c-State o 1oo, a, of Notary Public-State of'Florida)
E-LEN VA GHN
�? ;State:of Florida-
Comission N� a )4.Com' ission # G �g n No:
0,fit°� MY Commissio Expires
October 22, 022
REVIEWS FRONT ZONING SUPERVISOR PLANS- VEGETATION: SEA, URTL'E, MANGROVE
COUNTER REVIEW REVIEW REVIEW., REVIEW' "REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.