HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: 1 Permit Number:
.L'_. 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: A
i � c Property Tax ID #: �1 d CA J 410 �jV 5s_ � ,i ---- Lot No.
Site Plan Name: Block No.
r �^ { -
Project Name: # C�� I_ ,�; � T -- -
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
)<Mecha€ ical — 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:
OWNERAESSEE: - --___ -- CONTRACTOR:
Name IX W I
Name: DjU t r_ PC U Z
Address: 11Company:
City- NYl - �(A, I A, State: f7L
Zip Code: Fax:
Address:
City: 10 State:—] -
Phone No. { -1
Zip Code: Fax:
E-Mail: ' M
one No _1-
Fill in fee simple Title VYolder on next page if different
E-Mail
State or Co my License
from the Owner listed above)
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:
DESIGNERIENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
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 dome Owners Association bylaws
conflict with any applicable rules, or and covenants that may restrict or prohibit such
structure. Please consult with your Nome 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.
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�) ? M I I 0JJ 0 Vn ( I � 01/
Hato a of CWm6rrLdssVqContractor as Agent for Owner Sign re of ractor/Llcen a Holder
STATE OF FLORIDA STATE OF FLORIDA '
COUNTY OF �� COUNTY OF w
5wo to (or affirmed) and subscribed before me of 5w n to (or affirmed) and subscribed before me of
Physical Pres nc or Online Notarization hysical Presen r Online Notarization
this ]day of 202� by this day of L�1 1 4 202V by
Del f ,L P () well pk�(_e �C I LL 1 I
Name of person making statement. Name of person making statement_
Personally Known OR Produced Identification Personally Known —>OR Produced Identification
-
Type f Identification Type of Identification
Pr ed Produced
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(Signature of blNot St i a (Signature of N is-a� fit' k
•.-r Notary li: fate or rl rida N
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Commission. p GG 335507 r ,.
'",• itY. "e; Commission : GG 375507
Commission '.. sty Comm. Expires Ma S&R 2] a
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Banded through National Notary Assn. Bonded through National Notary ksr. .
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