HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN 0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : � � Permit Number :
Building Permit Application
Planning and Development Services
Building and Cod e Regu, at io n D i vis i on Com m erci
al Res *idential
2300 Virginia Avenue., Fort Pierce FL 34982
Phone : ( 772 ) 462 - 1553 Fax : ( 772 ) 462 - 1578
PERMIT APPLICATION FORL........ :
PROPOSED. IMPROVEMENT LOCATIONA L -----
Add ressWP
:
Prope rty Tax ID # : �Jy �p�— Lot No . 3-3
Site Plan Name : ^� &1CBlock No . �
Project Name : 1 _w
DETAILED DESCRIPTION' OF WoRK : ���_� -� AR ���:� . ..,���A� � ...,A .� .�. . . � s .
J
17L)
New Electrical Meter Second Electrical Meter
. ...........
- ------ .........
ii "- Itu
CONSTRUCTION INFORMATION : T *
Additional work to be performed under this permit — check all that apply :
_ M e c h a n i c a l _ Ga s Ta nk _ G a s P i p i n g _ Shutters Windows oors Pond
_ Electric _ Plumbing _ S p r i n k l e rs _ Generator _ Roof Pitch
Tota l Sq . Ft of Construction : Sq . Ft ., of First Floor :
Cost of Construction : $ � 6 � Utilities ; Sewer Septic Building Height :
OWN E
"M 19 M. -
". -AA WIM CONTRACTOR :
Name
Name :
Ad d ress : Company : — l ' 6
City : SL State :� Address : Q
Zip Code : � Fax : City : . �ie�� tate :� .
P h o n e N o . _ �� �. — a1 � �q Zip Code : Fax :
E - Mail ,, v Phone No � 1 -
Fill in fee simple Title Holder on next page ( if different E - Mail.. ri'LN1
-> ��
from the Owner listed above ) State or County Li ce nse_
If value of construction is 2500 or more,, a RECORDED Notice of Commencement is required .
If value of HAVC is Is or more, a RECORDED Notice of Commencement is required .
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIO N :
DESIGN ER/ ENGI NEERV _ Not Applicable '
MORTGAGE COMPANY : Not Appli cable
Name : Name :
Address : Add ress :
City : State : City :
Zip : PhoneZoState :
p � Phone :
FEE SIMPLE TITLE HOLDER : _ Not Applicable BONDING COMPANY: Not Applicable
N ame : Name :
Ad d ress : Address :
City : City4
Zi p � Phone : Z i p : 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, 161111111 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 permi t 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 113WNER : 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 attornLe before commencin work or recordin our Notice of Commencement .
...... ...............11
Signature Owner/ Lessee/Contractor as Agent for Owner Signa of Contra ctor/ Lice nse Holder
STATE OF FLORI �A STATE OF FLORIDA
COUNTY OFL k C. I �. .., COUNTY OF �� Lu� � �
Sworn r affirmed ) and subscribed before me of Swor to ( or affirmed ) and subscribed before me of
hysical Presence or Online Notarization Physical Presence or Online Notarizationthis � day of '1 202 � by t h i s � day of 1 2026
COMM%
Ills C
Mdft
Name of person making st ment , Name of person making scat ent ,
Personally Known Type of Identification OR Produced Identification Personally Known OR Produced Identification
Produced Type of Identification
Produced
( Signatur�e' f Notary Public- 5 o f i )
ignature Notary Publicm State I ri
Commission No. G \ oar �Ui Nota Public State of Florida
_ �; � ��ret E Montepare mmission No. � �O�''" Nip Nq(ary Public State of Flo id
My Commission GG 214990 IS EM garet E Montepare
~� a tieA Expires 06/05/2022 Y Commission GG 2149 0
p �d� Expires 06/05/2022
REVIEWS FRONT ZONING SUPERVISO R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW DATE REVIEW REVIEW
RECEIVED
DATE
COMPLETED
Rev . 5/ b/ Z
I