HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST V,- 'Ci,.,_t. L,ETED FOR -APPLICATION TO. -BE ACCEPI'Eu
Date:
Permit. Number: V" Vu&2,,j
F i
~ BuildingPermit Application
Planning and Developmentaervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)'462-1578
P,ERMITAPPLICATI.ON FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Commercial Residential
New electrical, Meter Second Electrical; Meter
Z
Lot No.
Block No.
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 Constr ion: Sq. Ft. of First Floor:
Cost of Co.nstructi Utilities: _Sewer _Septic Building Height:
r-a.1 Jl CJJ. V c�_ ACV % V
City: �-. 1(2- C� d r� State
Zip Code: 3 `/h9, Fax:
Phone N'o.�Ir ! -� ,2 �� C7
E-Mail: CQv-be
"II in fee simple. Title Holder on r:ext page ( if -different
from -the Owner listed above)
'Name:
Company:'
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction ,is, 2500 or more, a RECORDED Notice of Commencement'!s rec � ire
If value of HAVC is $7,500 or more, a RECORDED Notice.of Commencement is required'. '.
DESIGNER/ MA Mr.11%;
Name:
Address: State:
City: Phone
hon
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: 7
777",Not.Applicable
Name:
7,
Address' -777-state:
City:
Zip:.. Phone'
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as
I"cortify.that'n work orinsiallifidn" hascqmmenced-pdo.r.to,the issuance -of -a permit,.
subject structure
to ' build'the,
representation that it granting a permli`Will'author! 2p-.the'petiT!it holder that may restrict or prohibit such,
St. Lucie Couin makes no represen r and covenants may apply-
wh conflict with any applicable Home owners Association rules bylaws 01
suit wjth.�our Home Owners 'Association and review your deed for any e6stricticins which
structure. Please con and
that I Willi in all respects, perform the work
In consideration of the he granting of this requested permit, I do here
in• accordance with the approved plans, the'Florida. Building Codes and St. Lucie County Amendments.
e I pt'from undet'going a full concurrency review: room additions,
The following building permit applications are e.x m and accessory uses to another non-residential. use
accessory structures, swimming pools, fences, walls, signs,,screen rooms.- dt, in paying,twlce for
ord'a�-Noti�e.ofCaffirttencementfttaiy.resL,
WARNING TOX)W-,NE.ft:.Your .,faII.ure to. 90C h blic recor& of-. St..
t t�-beidc&dod1jn`t the pU
iti'66 6fCoMmencerrien � MUS 'fing cihg,consult
e'k to -Qur.p property ANc nL n
rcivem S . y. -rope I rk
, bef rethepnIyoimprovements
d' n the jobsite. 0.Lucqie County 4fid poste 0 wor recording vour Notice of,Commencement.
' der ci y before commencing
with lender - 7.
aiure of owner/
as Agent -for Owner
STATE OF FLORIDA
COUNTY- OF —
sworn tojor affirmed) and subscribed before me of
Physical Presen"e or online Notarization
this `e d by of 2apD by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produco—
of Florlda).
(Si n u of Notary Public to of Florida
Commission NO. 1 i[joijqnd/JVTbW111P8Pu09
&v,0Z'0ZJGqW0Q9a:S3UIdX4
REVIEWS I FRON3 ;a;MV0==
COUNTER IREVIEW
II [ T
RECEIVED
MPLETED
-signature of Contractor/License Holder -
STATE OF FLORIDA
CC!-U.0(Y,-,OF.-
Sworn to (or affirmed) and subscribed before me of
r Physical Presence or online Notarization
thisd 7— ay of
20 by'
Name of person making statement ) -
Personally Known - OR Produced Identification
Type of identification.
Produced
(Signature of Notary Public -State of Florida
Commisslon!No- (Seal)
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