HomeMy WebLinkAboutbuilding permitAll APPL}ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� I
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 IMPR `OVEMENT LOCATION_:
Address: IL i-\ - x '
Property Tax ID #:
Site Plan Name: �� C
Project Name: L L-
DETAILED DESCRIPTION OF WORK:
01
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
L
Addi X nal work to be performed under this permit - check all that apply
echanical _ 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: $ Utilities: __ Sewer __ Septic Building Height: _
Lot No._
Block No.
OWNER/LESSEE:
CONTRACTOR:
Name ( r-L
Name:
Address: - 0�
Company:
Address:
City: \mac f QJ State:
Zip Code: . L Gtl� Fax:
Phone No. '��� ^ l� 0 —Q la -5
City: _ 'k—r1 `(
Zip Code: a
Phone No —
Stater
Fax:
�—
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail L r
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State or County License
vac S3 p d
IT Value oT construction is LSUU 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:
Name:
Address:
Citv:
Zip: Phone
_ Not Applicable
State
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
Not Applicable
State:
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 fa.' re to Record a Notice of Commencement may result in paying twice for
improvements to your pr, erty. A Notice of Commencement mustyberorded in the public records of St.
Lucie County and poste n the jobsite before the first inspection. Itend to obtain financing, consult
with lender or an attsr v before commencing work or recordine vice of Commencement.
Signature of)5vpferXessee/Contractor as Agent for Owner
STATE OF FLO
COUNTY OF
S o to (or affirmed) and subscribed before me of
P ysical Pres e o Online Notarization
is day of 2020 by
Ila
Name of person making statement.
Sig��acto License Holder
STATE OF FLORID
COUNTY OF
w rn to (or affirmed) and subscribed before me of
Phvsical Presence or 1 Online Notarization
Name of person making statement
>1 sonally Know OR Produced Identification ersonally Known OR Produced Identification
entification ype o I ti ication
Prod d Produ
( ignature ry Pu is State of G a) ('gnature of No Public tate of Florida )
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Commission No. OSGGgZ0��5a�J) �°�9 Commission No. (Sea
RC) SENBER�
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REVIEWS eons ING SUPERVISOR PLAN G TO �1( 1ove 04 ANGROVE
REVIEW REVIEW REVIE °• I ed, REVIEW
DATE
RECEIVED
DATE - -- - - - -
COMPLETED