HomeMy WebLinkAboutBuilding permit appAll APPLICABLFI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( Permit Number:
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V E (2 C c b 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: '(Z i00t*,
PROPOSED IMPROVEMENT LOCATION::
_
Address: 00 A-r-10W5; tl me —
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
t
L
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
/Plumbing
Electric; J _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq_ Ft. of First Floor:
„ 0
Cost of Construction: $ 150' 16' Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name \Ci � t►�ULS
Name:_ 1� Imo` I(�
Address: t'0"J W
Company: 001M r I U�Ib r L-"�
City: V(�, ►Ac V % (1 kqC State:
Zip Code: t'i� -I Fax:
Phone No.
Address:
City: State:
Zip Code: TFax:
Phone No -1134 -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail pYety lt_PIN-
Sta e or Cou ty is se
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of CommencenwAt 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 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.
1 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 lender or an attorney before commencing work or recording your Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY �NP'�Io'
STATE OF FLORIDA ,
I't�IN
OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
Physical Presence or Online Notarization
this ay of 5 by
this day of —1624 by
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2r�1 1
I[NA i p Z�e-
Name of person making statement.
Name of person making statement..
Personally Known OR Produced Identifi t'•
Personally Known L---&R Produced Identificati
Type of Identification ?
Type of Identification •
Produced �•�
Produced_ go�
{ gnatur of tary Public- State of Florida)
(Signature f otary Public- State of Florida )
Commission No. (Seal) � �
ce
Commission No. (Seal)
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