HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � � ®" � � Permit Number:
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Building.Permit Application
Planning and•Developmentservices
Building and Code Regulation Division COmmerCial Residential
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 72�93 1'Q A&1:1G�
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILE'D:.DESCRIPTIONDF WORK: PRO fft
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 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:
OWNER/LESSEE: CONTRACTOR:
Name Name:• D-oxl46en
Address: Company:
City: State:r� Address: ggge
Zip Code: � Sd�i Fax: City: P7---!�)-uZC-e�- State:
Phone No. !22-�E—. :7z 7-7'2 Zip Code: ��S'� Fax:
E-Mail: Phone No 772, '.d G3'' ".�.4 464.
Fill in fee simple Title Holder on next page(if different E-Mail _ L . L S
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Count 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOgJDA STATE OF FLORI
COUNTY OF - G`� COUNTY OF � ��
Sworn to(or affirmed)and subscribed before me of Sworirto(or affirmed)and subscribed before me of
✓ PVIcal Presence or Online Notarization Ph sisal Presence or Online Notarization
th day of- Nv.�e,,•�10-Q� ,20� by this?Ja�ay of t`'� � 20-L-by
Name of person making statement. t Name of person making statement. '
Personally Known OR Produced Identification Personally Known OR Produced Identification "
Type of Identification Type of Identjfication
Produced Q Produced
(Sig n ture f Notary Public-S (Signature o Notary Publi 'n
MONIQUE M.CARLONI �►IQUE M,CARLONI
Commission No. a m t`I g� blic,State of Florida fN® ry P lic,State of Florida
c( �' Commission No. a-�� i �',l l®n#GG 269499
_ i Commission#GG 2694 2022
My comm.exoires Dec.10, My EbfEEI:gofes Dec.10,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
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