HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE.INFO MUST'BE%MPLETED FOR APPLICATION TO -BE ACCEPTED
Date:
Permit_ Number
Building P rmit Application
Planning and Developmem .3L- /ces
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)'462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:_
Project Name:
„�a� 1V1cLc1 second Electrical: Meter
Residential
fi— 3A�i �-Z
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply: .,S'j/qtfAAd-�
_Mechanical _ G'as '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 $ ; ;'e�(�— �y C Utilities: _Sewer _$eptic. Building Height:
NameD( n InI^sVI.hq#2 T_ ff
Address: ' GJo (n JIVLt,1,, d ,
City: State: _
Zip Code: '2,' Fax:
Phone No.
E-Mail: f►�+1� a Cc-yv,
Fill in fee si�D-r�fw,,,lder on next page ( if -different
from -the Owner listed above)
Name:
Company:
Address:`3ZA3 SW "-iCAC, S �-
City: P!/IL State: �-
Zip Code: 346153 Fax:
Phone No 77J, —a &+—
E-Mail
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.
Not App
Name: '
Address: State:
City: Pe
Zip: hon
FEE SIMPLE TITLE HOLDER: NOT J'►P,Pi1udU1U .
;i Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: ' k
Address: State
City:
Zip: 1 Phone,
Not A plicable
BONDING COMPANY: p
Name:
Address:
City:
Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a pe
f certify that no;work or'inslallatioi.ri has.eommenced prior.to the issuance of a perm
St. Lucie County makes no representation that is granting'a permit will ator a
which is in conflict with. any, applicable Home Owners As rules,.bylaws
structure. Please consult with1our Home Owners'Association and review your deec
In consideration with
the granting f this lansrthe Floridequested a .gu Iding Codes and St Luce Cot
it, I do hereby agree that I �%
in accordance with the approvedp.
The following building permit applications are exempt from undergoing a full conci
accessory`structures, swimming pools, fences, -walls, signs,,screen.rooms.and acces
NER: Your failure�to Record a Notice.of Commenceme
WARNING TO OW
Irnpovements to'your-pcope;rty: A Notice,.of Commencement rn�
Lucre Count ed on the jobsite-before ttfe first,inspectior
with Gder an attorne efore commencing work or recordin
as Agent for Owner Signature
nit to do the work and installation as indicated.
3eem.it holder to'build the subject structure
I
any restrictions which may appl habit such.
, in all respects,: perform thel work
ty Amendments:
:ency review: room additions,
iry uses to anotherfnon-residential.use
t may resultm paying;twlce.for
t tie recoided in`the,publlc records of'St:..
If yow: intend to obtain finericing; consult
dour Notice of Commencement. -
Holder .
STATE OF FLORItuA
STATE OF FLORIDA LI 000NTY-;OF.L
COUNTY":OF ��IAa
Sworn
Sworn to (or affirmed) and ubscribed before me of n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Pres nce or Oniine Notarization , 20_ by'
20A by r this day of
this d"ay of +�
Name of person making statement.
Name of person making statement.
OR Produced Identification.
OR Produced Identificationy Personally
Personally Known — Type of Ide
Type of Identification Produced_
Produced
Sig ature of Notary Pu ic-'State of Flori ) . (Signature of NotaryPublic—State of Florida)
HM{NG (Seal)
1 Ahi.Rp Commission �No.
Commission No.
,1 ; �� •; �__ MY COMMISSI N i# GG 275060
EXPIRES: Decembec20, 2022
Fo'FF;° Bonded Thru o
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