HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ^
Permit Number;
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax. (772) 462-1.578
I PERMIT APPLICATION FOR:��-[ QMft
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PROPOSED IMP 1 _
- RiVEMENT LOCATION: I
Address:
Property Tax ID #:� ' �,„ F J w Lot No.
Site Plan Name: Black Na. 'k)/A
Project Name:�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
— Electric — Plumbing —Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ ' �_ _
OWNER/LESSEE:
Name
Address:
_ shutters _ Windows/Doors Pond
—Generator Roof Pitch
Sq, Ft. of First Floor:
Utilities: —Sewer —Septic
Cit ;
Y° State:���
Zip Code: ` Fax: —
Phone No, I - T�_'
E -Mail: T"' & 6 .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: .W--y Company:
Address: f
CitY101" '
Building Height;
State:'
Zip Code: !'' '
L [ g"" Fax:
Phone No
E-mail
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: 4
Not Applicable MORTGAGE COMPANY:
Not Applicable
Name:
Name:_
T
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: Prone:
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 commencedprior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit wik 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, walis, 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,,) ou tend to obtain financing, consult
with lender or an attornev before commencing work or record -A your Notice of Commencement.
I J-1 r-
C�� A av_
Signature 0 Lessee/Contractor Agent for Owner
. /4�
" Contrac Holder
of er/ as
Nnat re of r/License
STATE OF FLORIDA
STAT OF FLO
COUNTY Cif f 7 !] r ;
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COU O i Q y4f r% _-- -
Sworn/to (or affirmed) and subscribed before me of
Swowto (or affirmed) and subscribed before me of
ysical Pr once or Online Notarization
P
✓ ysical Presence or Online Notarization
day of _f .' J7, zQ20 by
this day of0,'',�G(-?Y+tt 3�_ 2020 by
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of person making state ent.
,:
Name of per making statement. w;•
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c'P
ally Known OR Produced Identification
Personally Known OR Produr ed ld :rftffi a on
-.T"t
f Identification"-
Type of Identificatia }
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Produced
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{Sig Lure of ry Public- State of Florida
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