HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST 13E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)'462-1578
Commercial Residential
PERMIT APPLICATION FOR: Qs,ro, r C ordo v c..._.
Address: `'(f OD Alj-(�_c,L..�c.
Property Tax la #: I ~ta 3 - _S a 1 6 b 1 Z_ DO o - 7 Lot No.
Site Plan Name:
Project Name:
New electrical Meter Second Electrical Mete
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ G an ^ Gas Piping Shutters Windows/Doors Pond
Electric —Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: O Z5
Sq. Ft. of First Floor:
Cost of Construction: $ _ boo • Utilities: —Sewer —Septic Building Height:
Name Q 5 i
Address: Yf0 a
City: r 'State: r L
Zip Code: Fax: - ---`
Phone No. e
E-Mail: A ckn;
Fill in fee simple Title Holde(on next page ( if different
from the Owner listed above)
Name: /:I{ _
Company -
Address: SCJ rM - G'f1
City: S State: �C
Zip Code: .3I Ie( Fax:
Phone No 7 2J. d,J 7``. Spn
E-Mail n /c4.n p. r 4 as
State or County License C1
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.
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DESIGNER/ENGINEER: Not Applicable
Name:
Address: State:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER' Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: __ Phone:
,Not Applicable
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 is of a permit,
St. Lucie County makes no representation that is granting a permit will abtlawszor and coo nano ther at may the subject
prohibit such
which is in conflict with any applicable Home Owners Association rules, y
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 l 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,
It wimming pools fences walls signs screen rooms and accessory uses to another non-residential use
accessorystru s
WARNING TO OWNER: Your failure to Record a Notice pf Commencement may result in. paying twice for
be recorded in the public records of St.
improvements to your property: A -Notice of Commencement
County on the iobsite before the
must
first inspection. if you intend to obtain financing, consult
Lucie and posted
with lender or an attorneybefore commencin
work
or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Co tractor/License Holder. .
STATE OF FLORi
STATE OF FLORIDA
COUNTY OF
COUNTY OF J t t C �
Sworn t or affirmed) and subscribed before me of
Pr ence or Online Notarization
Swornbed
stocal Pres nee o and subscri
li a Notarization
2� by
this y of 20Q -by
this ay of
J
-
Name of person aking statement.
Name of pens making statement.
�OR Produced Identification
Personally Known `� OR Produced Identification
Personally Known
Type of Identification
Type of identification
Produced.
(Signatu
TANYANEVILLE
:ommis •N _ ': OMMISSION # GG 2i l )
:•:
d' EXPIRES: October 12, 2022
.I '•'.'t;,. �'a?:•' n,•,•,,,,r Thn. m tary Public underwritm
REVIEWS I FRONT i ZONING
COUNTER I REVIEW
RECEIVED
COMPLETED
MY COMMIssiON # GG 25¢$r3$al
Commissi eS7mober 1l2, 2U
Bonded ilttu Notary Public Unde- em
SUPIRVII
REVIEWOR REVIEW VEGETATIREVIEW ON SER VIEW �MANGROVE
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