HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit.Number:�Ooq- d (/1
1S
Building Permit Application
Services
Planningand Development
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:
Ti
t - 'c - . f ♦ ' '3af a S N'ICe� .. }!... - .
V.r
Address:
Property Tax ID#: 1`30/ o/% OD03 Lot No.
Site Plan Name: Block No.
Project Name:
New electrical Meter Second Electrical Meter
�}as `�"�k. B�R�'�st� ��fi�� -xr'atr�i +'"� ;'t�"`�,"�; r �T""a�-� a���ky'•��,. �•'�� :��
Additional work to be performed under this permit—check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing —Sprinkled _Generator Roof Pitch
Total Sq. Ft of Construction: � � Sq. Ft. of First Floor:
Cost of Construction:$ i�7. r C"�D Utilities: —Sewer —Septic Building Height:
i.F"^"_:?rr.. ,•5•as^`-.c.�w;.+-r +•1.5i"7..J <t+.:.rEYa ,,� ,•cs.-G' +'r,4•.,rt -tE,'Ar 'S:.'i'^.Y.. i"^ >- 'R�-Lwii{'� u
_4 w'S `•{. r & a i
'�f." F x: §. a" k:<�pF,,•ma'� . ;�.A$' gi"A '� x. i'+•
:,f '?r,'� Srs?r3 n➢: •4 �rert+'.'s`c' ak'�.°.. .�h'7t ".{.�..�.:.�;;1"{. ^r'..�"e1.« �.}."t�1.'.s>xa". .��"aa::?SY�'.1w15.yu.?..�rl: .s� .x'a` t.u ....`3xil
Name Name:
Address: 100 Company:
City: (i' State: Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (i different E-Mail
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.
DESIGNER/ENGINEER: t 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 priorto 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.`inthe public.records of St..
Luci County and posted on the jobsite before the first inspection. If'yod intend to obtain financing,-consult
wit lender or an attorne before commencin work or recordin our Notice of Commencement.
Sign w e�ee/co as Agent for Owner Signature of Contractor/License Holder .
STA E OF FLORIDA. / STATE OF FLORIDA
C,.OUNTY OF S I �U C.r� COUNTY OF '
worn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Prese ce or Online Notarization Physical Presence or Online Notarization
this X day of 20 M by this day of 20_ by
Name of person r4king sta ment. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
PrEduced Produced
tm
(S' tiii of Notary Publ -State of FloriA . (Signature of Notary Public-State of Florida)
� vaq LAS' ��1 i73,'�P;v" Ze2
G
Commission No. °' •;•;,.. 60Commission No. (Seal)
?''..PIR[cS;Derem2
;4•.....
REVIEWS FRONT ZONING SUPERVISOR PLANS' VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.