HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO//MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (,
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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:
PROPOSED IMPROVEMENT LOCATIQ(V 1 ` u v v '
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Address: O..a ��✓,,./. f_. 1+ j 9 2
Property Tax ID#: - (`�• Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit-check all that apply:
4Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ �..(U 6- Utilities: _Sewer _Septic Building Height:
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OVI%NER�LESSE rf. F , �r �� s CONTRACTOR ,
Name ;L� Name: 14/�%/`f4/y4 gL
Address: bo Company: 1q6'J-1'l fit& F__
City: %OR-T 1 C/t Gc State: ��L Address: �3 yrs .S4-00N4 f.3 L-Vj '
Zip Co e: 3 y Cj e Z Fax: city: f B/L S elCf State:r-L
Phone No. '? 7 Z fl -n j q332 Zip Code: c/ 9 5.3 Fax:
E-Mail: Phone No 7 7 3
Fill in fee simple Title Holder on next page(if different E-Mail_ /yid/t S Q lj-QrI�-�yQ�e oo. GD rvl
from the Owner listed above) State br County License /2413'0, 75_77
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.
SUP.PLEMENTAL`' CONSTRUCTION LIEN LAW INFORMATIOIVY4
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 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 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 qran attorney before commencing work or recording our Notice of Commencement.
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Signature of caner/Lessee/Cbritraftor as Agent for Owner a ure of ontract /License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF �• o�r/�/1- COUNTY OF Cly
Swor o(or affirmed)and subscribed before me of Swo to(or affirmed)and subscribed before me of
Physical Prese Ice or Online Notarization Physical Presence or Online Notarization
this 7 day of d 4T: e20,by this 5 day of ft( 60 2020 by
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Name of person ma��7
a t. Name of person making state grit
Personally Known VProduced Identification Personally Known OR Produced Identification
Type of Ide ' ication Type of Identification
Produced Produced
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WIRE&July 01,2023 ® EXPIRES:July 01,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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