HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n 5 0
Date: l�uTi Permit Number: � l/ U
CArm.. M
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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:
Address: & Ael JVaw-_T<'�
Property Tax ID#: �� 1 Dn 1� W Lot No.
Site Plan Name: Block No.
Project Name:
Co r4
New Electrical Meter Second Electrical Meter
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:,gO Sq. Ft. of First Floor:
ty-
Cost of Construction: $ r_ox Utilities: —Sewer _Septic Building Height:
Name Name:
Address: r 11 �_ Company:
City: /e 1-C State:�� Address:
Zip Code: Fax: City: State:
Phone No. 83— -_'Cd' A Zip Code: Fax:
E-Mail: L.Aq� 42 0-6 ,G6o_1,, Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) 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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
-Zip: Phone Zip: Phone:
FEESIMPLE 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 conflict with any applicable Home Owners Association rules, byla`ws-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 theJobsite before the first;inspection. If-you intend-to obtainfinancing;,consult
with lender or an attorney before ommencin work'or recording our Notice of Commenc`ement..'
S g attire of Own r/Lessee/Contractor s or wner Signature of Contractor/License Holder
STATE-OF FLORIDA e -STATE OF FLORIDA
COUNTY OF J UIcke COUNTY OF
Sworn 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 day of �C�� 20; by this day of 20_ by
Ck
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ` Type of Identification _.
Produced 1— Produced
(Signature of Notary Pu lic-Stat o o da) (Signature of'Notary'Public-State of Florida) ._
Commission No .``PPYPV i ELLEN V ��'� Commission No Seal
Florida ry Public
_* f= Commission #GG 270079 -
e` n Ex Tres
OCtObP.r 22�2 22 __.:.
REVIEWS � ISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.