HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .� Permit Number.
Building Permit Application
Planning-and DevelopmentServices
Building and Code Aegulatfon Division Commercial Residential
2300 i irginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMITi4PRLlCATiON FOR: e'd�lt✓eveel-e fv e;t:,J511INA
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Address;
Property Tax ID#: ���CO��'� 1 �0l _ Lot No.
Site Plan Name: Block No.-
Project Name:
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ill •% �f/r+ �•//�''^T" ,�✓U yt l �� 2� '� � d �s.Q�i�' •
New electrical Meter Second Electrical Meter 19-e I-eoo eql
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Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank Gas Piping ^Shutters _Windows/Doors _Pond
_Electric _Plum ping —Sprinklers _Generator Roof ' Pitch
Total Sq.Ft of Construction: Sq. Ft. of First Floor:
- off a etion $�: ✓��� ' � Utilities: Sewer _Septic Building Height:
,� �fY " ^ $pYz.��° `''���"e• ,'�.4`-.��^ �z:r.,.^,r•� 'i+r ``".•"_s' - �c �t-�;'t�r �rit -Y.„.-s.,;it_'t'�""� �.7''-�. :�ra•a��y[�tc�£3
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Name f._V:� ' / Name:
Address: 1/0 ;'G�Ps/'�4Z/ �l Company:
City: 1�f &Z,- e State: /r-& Address:
Zp Code: Fax: City: State:
Phone No. 4- Zip Code: -Fax:
e
E-Mail: /.[. eve 5&7& �% ?�li• �'®� Phone No i
Fill in fee simple Title Holder on-next page(if different E-Mail
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.
DESIGNER/ENGINEER"t Applicable MORTGAGE COMPANY: . Not Applicable
Name, Name:
Address: Address.
City State: City: -Zip: Phone—Phone Zip: Phone:
PEE SIMPLE;TITLE HOLDER: Not Applicable .BONDING COMPANY: Not-ApplicaW
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 ceitify that no work.or Installation.has commenced prior to the issuance,of a permit.
St Luce County makes no representation that fs granting a permit will authorize the permit haldeko 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 consultwrth-your Home Owners Association and review yout deed for any restrictions which may apply:
In consideration of the granting of'this requested permit,I do hereby agree that 1 will,In all respects,perform the woflc
in accQrdance with the approved plans,the Florida Building-Codes and St Lucie.Cognty Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessary structures,-swimming pools,fences,walls,signs;screen rooms and accessary uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Cornmeripment,may:result in paying twice for
improveme,ntsto.your property.A-Notice of Commencement must be recorded'in the public records.df St...
Lucie'County and posted on the jobscte before the first inspection."lfyou•intend to obtain financing,consult
with lender-or an attornev before commencine work or recordifig ypqr Notice of Commencement.
E Ignature of Owner/Lessee/Contracto as Agent for Owner Signature of Contractor/license Holder
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OP—' _ U rage.. COUNTY OF
Swam to(or affirmed)and subscribed before me of Swam to(or affirmed)and subscribed before me of
Ph ica{Presenc or Online Not nation Physical Presence or Online Notarization
this day of 20 �y this day of .2C by
I
Name of person making statemen Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatii Type of Identification
Produced l. _ Produced
(Signature of Notary Public-Stat ? ). Si nature of Notary Public-State of Florida)
n=State Of FIO jl��qUG N
Commission No. °�FF +-a1 othrnfgafon�Nota yrMI Ion No. (Seal)
tbth l)� j 00 700�g
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REVIEWS FRONT ZONING SUPERVISOR S.
VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.