HomeMy WebLinkAboutBuilding permit app►II APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
' Building.Perrnit Application
.cation
Planning and'DevelopmentServices Commercial 1/ Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579
PERMIT APPLICATION FOR: bI f i(
PROPOSED IMPROVEMENT LOCATION:
Address: q y30 S -�---
Property Tax ID #:
site Plan Name: _
Project Name:
oa - I y - 0-
DETAILED DESCRIPTION OF WORK:
— —+al—�
r0 a r G
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
Electric — Plumbing _ Sprinklers
Total.Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
— Generator
Sq. Ft. of First,Floor:
Lot No.
Block No.
Windows/Coors _ Pond
Utilities: _ Sewer Septic
CONTRACTOR!
Roof Pitch
Building Height:
Name �t I I (JYv ��11eS �L-G Name:
Company:
I
Address:
city_ '`�'^ �n -State, � Address:
City: State:
ZIP code: I 1 J ifs Fax
Phone No. z;p cod'.0 �G-�
PI Fax: 7721d''S/ql/
E-Mail: Phone Na
Fill in fee simple Title Holder on next page (if different E-Mail
G, CGYY)
from the Owner listed above) State or ounty License `��/�/��y -
If value of construction is 2s00 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:
City: State:
Address:
State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _✓Not Applicable
BONDING COMPANY: L.,/Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wori and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
conflictaprohibit such
your deed any t ons ch maor
structure.
restrithat
lease cconsult withpyour Home Owners Association'andrreview for whiay
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 before commencing work or recording our Notice of Commencement.
Zv
Signatl6re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Helder
STATE OF FLORIDA� L
STATE OF FLORI
-i', LucA P.
COUNTY OF c 7i Lur ,.e�
COUNTY OF c
orp to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
by
Sworyi to (or affirmed) and subscribed before me of
✓ P y IcaI Pres�ce o Online Notarization
thisgdayof 20-Zby
is day of _ rnhe,' 20�
:o
-
Name of person making statement. q`I
"
ame of person making statement.
E
rsonalIy Known L/ OR Produced Identification
Personally Knowny OR Produced Identifica It
V
ype of Identification
Type of Identification �—
roduced
Produced a
ignature of Notary Public- State of Florida }
(signature of Notary Public- State of Florida ) d C1 n o
(y
6
Commission No. -6 { �� .3.3 (seal)
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Commission No.�(9-9/(o ( )
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PLANS VEGETATION S TURTLE MANGROVE
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW REVIEW EVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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