HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Residential_
PROPOSED IMPROVEMENT LOCATION:
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Address: ) % �L/\� `�F��%�� 0
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Property Tax ID#: vCiL PkQY, -Oflt ' ti Lot No.
Site Plan Name: Block No.
Project Name:
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: W 2'tIc)
Cost of Construction: $ ) 0 , C ,� t l Utilities: —Sewer _Septic Building Height:
QWRER/tESSEE:
CONTRACTOR:
Name
RIV
Name: 5IA ✓`I lJ �tJ) 1 "�
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Address: i 1 IV is iq lP 0, f V
Company:
City: f� r T 5T, LA C i e State: -E�
ZipCode:.3g6i V Fax:
Phone No.
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:l/1/Cr N��`�Y�CrI�1��) ,111 �1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice or Commencement is requvea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Nam
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Address
City:_
Zip:
MORTGAGE COMPANY: _ Not Applicable
Name:N�—
Address: �u RexoZ
City: PnwAS State: Tic_
Zip:1S2(aL-okk; Phone:'— w3 - 4 S 1
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
withle,nder or an a£torne)pbefore commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contra or a gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Physical Presence or Online Notarization
this _ day of Al a it ' F 2020 by
this_ day of 12020 by
Name of person making staifement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Si nature of Notary Public- Staluoft,
a hICOLE O.ANNUNZIATAh
ig
ture of Notary Public- State of Florida )
MY COMMISSION 6 GG 92
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Commission No.�.?� 0✓
{,ea VU: February to,2
Corr
ission No. (Seal)
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REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.S/6/20