HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O
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: l
PROPOSED IMPROVEMENT LOCATION:
Address:
' — Lot No. Jr
Property Tax ID #:,/�
�52
Site Plan Name: �lQ/�2D7.�cS(1 ca"
1 o? Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
4 166 ram, lv �w
�si J
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: Sq. Ft. of First Floor:
Cost of Construction: $ % 1 00 • 3 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /' Q Name: dX—J
Address: 5 Company: /"
City: State: � Address: l/ ko__
i Zip Code 5 Fax: City: State:
Fax: �~
Phone No. Zip Co-ddee:7��
,_
E-Mail: Phone �I�Ji
Fill in fee simple Title Hol er on next page ( if different E-Mail
from the Owner listed above) State or County License 8 ��
L
If value of canstrurtion is 2500 nr mere_ a RFCORnFn Nnfiro of Cnmmonro,nen+ ic .en"I A
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone —
FEE SIMPLE TITLE HO R:
Name:_
Address:
City:
Zip:
Phone:
Not ApplicaNe
State:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
I
Not Applicable BONDING COMPANY:
Name:
Address:
City:_
Zip:
Phone:
Not Ap
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made tgZbtain a permit to do the work and installation as indicated.
I cefy that no work or installation has commenced prior to the issuafice of a permit.
ucie Count makes no representation that is granting a permizimill authorize the permit holder to build the subject structure
���+ hich is in conflict with any applicable Home Owners Assoclatirsri 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
improrvements to your property. A Notice of Commencement must be recorded in the public records of St.
�rhlenderoranattn
County and poste on the jobsite before the first insp�n. If you intend to obtain financing, consult
before commencing work or retordi , g your Notice of Commencement.
Of
STATE OF FLORIQA/J p
COUNTYOF
as Agent for Owner
Sworn to (or affirmed) and su cribed before me of
Ph sical Prese or Online Notarization
this _ day of 2020 by
Name of person making statement.
Of
STATE OF FLORID���
COUNTY OF
Holder
Sworn to (or affirmed) and subscribed before me of
Ph s'cal Prese r Online Notarization
this ji of _ 2020 by
Name o person making statement.
Known OR Produced Identification � Personally Known OR Produced Identification_
ntification— I Type of Identification ;
(Signature of Notary PullcArV o t a
Notary Public State of Florida
Char[�ni�n�Q, Walker
Commission No. " '- My Cm�atli,on GG 225827
ee Expiros 06106/2022
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED_
DATE
COMPLETED
ev a1� f
U vvalKer
My COmnlission GG 225a2.'
expirss 06/06/2022
PLANS VEGETATION
REVIEW REVIEW
SEA TURTLE MANGROVE
REVIEW REVIEW