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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE Date: UST BE COM's, �` 13 FOR APPLICATION TO BE ACCEPTED 'L Permit Number: RECEIVW Building Permit Application AN 9 9 2011 Planning and Development Services Building and Code Regulation Division Commercial Residential in - Permitting 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address Property Tax ID #: Site Plan Name: Project Name: _ :/—�`-7- New Electrical Meter Second Electrical Meter 0 Additional work to be performed under this permit —check all that apply: Mechanical Gas Tank _ Gas Piping _ Shutters Electric _Plumbing _Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ .:2 36-6 Generator Sq. Ft, of First Floor: Lot No._ Block No. Windows/Doors _ Pond Roof Pitch Utilities: _Sewer _Septic Building Height: me G V Name: Na Address: ? II �. Company City: V+ r G State: r ` Address: ' Zip Code: Fax: City: State: Phone No. e2 t3,- ® 3 Zip Code" Fax: E-Mail:/�rror� `: L© Phone No Fill in fee simple Title Holder on next page ( if different E-Mail. from the Owner listed above) State or Cdunty 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: _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Name: Address: Citv: Zip: Phone:. Not Applicable State: BONDING COMPANY: Not Applicable Name:_ Address: City:_ 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 IPnr•IPr_a.r ;ih attnrnPv hafnre cnmmencing work or recording vour Notice of Commencement. Signature Own ssee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORID STATE OF FLORIDA . COUNTY OF S LUZ.i� COUNTY OF Sworn 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 2 day of '::S (s1 , 2011 by this day of , 20_ by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification Type of Identifica 'on Produced Type of Identification Produced (Signature o Notary Public- S to of Florida) 0;c (Signature of Notary Public- State of Florida ) Commission No. (Seal) CD o d = Commission No. (Seal) < WM mn�oD ;3wo2 REVIEWS FRONT ZONING SU ,.ji&ID�i PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW kg REVIEW REVIEW REVIEW REVIEW DATE Nm�d RECEIVED M'2 °D ` O DATE @ N 70 to COMPLETED ev.