HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 "2.+_ Permit Number:
C H I 11
P L, C `� c >J t� 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: roO
PROPOSED IMPROVEMENT LOCATION:
c 1- i JA B
Address: ii cc
Property Tax ID#: 1_ Lot No.
Site Plan Name: 900 I 10, Block No.
Project Name: 1
DETAILED DESCRIPTION OF WORK:
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PTA
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:$ ;M 3 ( 00C Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR.-
f
x ..
Name _ Name:
Address: Company:
City: State: Address: Ala 7-
Zip Code: . Fax: City: State:
Phone No. Zip Code: Z-_ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail KI
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: City:, State:
Zip: Phone Zip:_ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: 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 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
with lender or an attorney before commencing work or recordin our Notice of Whmencement.
Signature f Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF COUNTY OFORIDAFLORIDA
COUNTY'OF C
Sw n to(or affirmed)and subscribed before me of Swo to(or affirmed)and subscribed before me of
P sical Presence or Online Notarization ysical Presence Online Notarization
this day of 12020 by this clay of 2020 by
Name of erson making statement. 11 Name of person ma7011
tatement.
Personally Known E OR Produced Identification Personally Known Produced Identification
Type of Identification Type of Identification
Produced Produced _
1. --- ^�
e of Notary Public-St t„ " Spridi OMMISSION#GG165113Q i na of otary Public-Stabrida)KATNER;NE HAVENSr.. _ My COMMISSION#GGi 65030
E hmgh 1st State insurance Commission No.
IRE&DEC 04,2021
Commission No. "F��oa°'` oP (S9J9ES:DEG 04,2021
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Bonded through 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20