HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )
Date: Permit Number: OC ®� I.03gq
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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:
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PRO,FOSEDIMPR®,UEMENTLOCATION�
Address:
Property Tax ID #: 3`7 W— J: S' 60D/ — ,M — 7 Lot No.
Site Plan Name:%%L�� Block No.
Project Name: �dwer
New Electrical Meter Second Electrical Meter 16;rrzm&AA- i
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: / 61 Sq. Ft. of First Floor:
Cost of Construction: $ 's—n oo t-C)o Utilities: —Sewer —Septic Building Height:
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Fill in fee simple Title Holder on next page (if different
E-Mail /�( %��l�E 6 1677
from the Owner listed above)
State or County License
If value of construction is Z500 or more, a KtLUKUtU IVOLIGe Of %.V1i1111C111.Cl I lug IL W Icyu 1
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
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:
City:
Address:
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 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 1®4adPr nr an attnrnev before commencine work or recording vour Notice of Commencement.
5S�iwner/ Lessee/Contractor'as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Swor to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
� Physical Presence or Online Notarization
Physical Presence or Online Notarization
this �2day of A.P 2020 by
this day of 12020 by
1"in
Name of person making statement.
Name of person making statement.
Personally Kno OR Produced Identification
Personally Known OR Produced Identification
Type of Iden catio
Type of Identification
Produced Cr.
Produced
(Signature of Not r
(Signature of Notary Public- State of Florida )
AUDREY B. HUMPHREY
Commission No.
MYCOMM(MI03#13G300817
Commission No. (Seal)
EXPIRES: March 6, 2023
:ter•..: • a. '
Bonded Thru Notary Public Jndermiters
tel:
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SUPERVISOR
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/"ZU