HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �t -=s)- &) Permit Number:
L1; i
L- L `' � L F 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name: CLY 1Dtmca—
I DETAILED DESCRIPTION OF WORK:
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: $
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: "Cc"
Address:�4� �S /<7%�/
Company:l`�t��CP: �rciC�►f�
City: J e�� Q �^ ,���►- State:
Address:�Q i r� 1CIcz��CatT k-
Zip Code: 3"f 9r 7 Fax:
City: _t-%1 &-yt) (Q t I) State: j_
Phone No. 7 7 A — 4%JO6"'f3J'fl
Zip Code: �X��� LI Fax:
hone No `% !)Ci 3SA-1io}32
E-Mail:WQV'k5 tiAV` 7P6juAe_.gS �_WQ
Fill in fee simple Title Holder on next page ( if different
E-Mail (A ( C` leCA(Yl KC; u CX: ry-)
from the Owner listed above)
State or County Licensed fj�C 12,E
it value of construction is Z5UO 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
Name:
MORTGAGE COMPANY: Not Applicable
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 attorne re commencing work or recording our Notice of Commencement.
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S1 Lucy' e—
STATE OF FLORIDA
COUNTY OF F.
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this /day of CJe v r 2020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of Ck r 2020 by
MCQ1tai,W _5�hOL ,�k W
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification J
Personally Known >C OR Produced Identification
Type of Identification
Type of Identification
Produced_
Produced
(' nature of Notary Public- State of Florida)
Signature of Notary Public- State of Florida )
Commission No.QG C'i S 9 O.S Seal
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Commission No. ;•:!••. ALLIS��D�tAW
* :*; Commission # GG 986365
Expires Jul 4, 2024
9F p�•,, Bonded T* Tro Fain Insurance 800 38S 701
PLANS VEGETATION SEA I UK ILE
REVIEW REVIEW REVIEW REVIEW
REVIEWS
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DATE
RECEIVED
'�'�
, 2024
DATE
COMPLETED
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