HomeMy WebLinkAboutApplicationAll APPLICABLE INFMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C/ / 3 CZ Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
c S ----0 l --00 Ce --
Residential
Lot NoY"
Block No.
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION;
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 Construction: c �-) Sq. Ft. of First Floor:
Cost of Construction: $ �J l� , ---� Utilities: _ Sewer _ Septic Building HeighV. —
OWNER/LESSEE: -
`
CONTRACTOR:
f -
Name ,.- 1
Name:
Company. i l��
Address: c✓
City: 1 6State: R�-
Address: S 5- S
Zip Code: Fax:
City: � Y4N Statek I
`
Phone No, �J `� 1 D " ' S - ���
Zip Code: Fax:
Phone No3 en
E -Mail:
Fill in fee simple Title Holder on next page (if different
E -Mail _ X\
State or County License
from the Owner listed above)
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 LEEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: _ Phone:
City: State:
Zip: _� Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 or an attorney before commencing work or recording vour Notice of Commencement.
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Signature of Owner/ Lessee/ n rac s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID/:- j�- 1�
STATE OF FLORIDA-�--���
COUNTY OF �r �`�'
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presen a or Online Notarization
Physical Presence or Online Notarization
2020 by
this day ofbl;S
this 14 day of 2020 by
ti fJN1
S i /jUN
Name of person mak in statement.
Name of person making stdtement.
Personally KnownOR Produced Identification
Personally Known --f< OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
( gnat a of Notary Public- Stateof rida)
(Signature of Notary Pu 'c- St a of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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