HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
Suilding.Permit Application
Planning ond'DevelopmentServices
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: -
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PROPOSED IMPROVEMENT LOCATION:
Address: b- S 0 I l c) l J
Property Tax ID #: `t � - LX),"t - h I L.4 4 - ( oo-a Lot No.
Site Plan Name: (`xQ_ �' Slrl Gik i �a10 1r- _ 'i Block No.
Project Name: G� i L i
DETAILED DESCRIPTION OF WORK:
T�
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 j�Plumbing —. Sprinklers ^ Generator Roof Pitch
Total.Sq. Ft of Construction: Sq. Ft. of First'Floor:
Cost of Construction: $_Q� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name. c U_D T1 lC�.ir'
Address:\SI 0
Company•TIZ4cz
City: Stater
Address: Jl~i�5'?S' �Ge illU
_
Zip Code:,2�S�i Fax:
City:(ic1 d.� State:
Phone No. (L(
Zip Code: c LlglSgi Fax:
E-Mail: \\Jvl Gi�r7 .Ai .C;�'W1
Phone No r7!2__ -,;;,A7' 73L(
Fill in fee simple Title Holder on next page ( if different
E-Mail I Lb, h .
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
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, wails, 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 hefnrP rnmmanrinc wnrlt nr rarnrriina vnnr Alntirc of rn►n rmnnr•arr.nn}
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SWiaare of Owner L ee/Contractor as Agent for Owner
Signature Contractor/License
of
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
Physical Presence or Online Notarization
Physical Presence or
Online Notarization
this day of _ . 20_ 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 Identification
Type of Identification
Produced
Produced
(Signature of Not ublic- State o gada) MICHAELRW
It
(Signature of Notary Publi
ride )
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Expires July 28.2023
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