HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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L' `L 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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PROPOSED IMPROVEMENT LOCATION:
Address: (�u,
Property Tax ID #:
Site Plan Name:
Project Name: S
DETAILED DESCRIPTION OF WOR
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Lot No. Z.
Block No. t4/ fN
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otT a�/lV VxPlu 5�d ivtia� �s 2/I'C 'vtln • -
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
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $3k,Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: '
CONTRACTOR:
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Name: \�rt�.� V\k0��
Address:
City: zoac State:FL
Zip Code: $u(Ael� Fax:
Phone No.loj`i. ^ 51C1—C\IS
Company:�p,A�,de
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NtA<"t1N N '
Address: 19 4 n\ou
City: sihK1><�n State: L^
ZipCode:SggqCI Fax: WA
Phone No 1a7. '2)
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail_
State or County License f L. ( _ .131* 1055
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:P
Address:
Address: q0 1 Pi <) ma
a Woe
Qk . S*4r 100 t- $7.0
City: State:
City: Stater
Zip: Phone
Zip: G Phone: &15- UgSs -a£s4t
FEE SIMPLE TITLEHOLDER: _ 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
fli which is in conct 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
th lender or an attorney before commencing work or recording our Notice of Commencement.
Ln 'M C
MAf
ature of Contractor/License Holder
Sig
Sig re of mer/ ssee/Contractor as Agent for Ow
S E OF FLORIDA
STATE OF FLORIgp��
YOF- �N\Nl
COUNTY OF Y�erVtin
Sworn to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
V P ysical Presence or _ Online Notarization
Physical Presence or Online Notarization
this day of 1.0 202k by
_
this `'day of q�vl.M aW6 by
NaWe of persob making statement.
Name of person making statement.
Personally Known OR Projigi dentiltaUK"
Personally Known OR Produced Identification
Type of Iden"i tigq�\ Shift ofFW44
Type of Identification
Produced VV ` I �InbnBgih 11!A
duced
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(Signature of Notary Public- State of Florida)
(Sign tur
Commission No. I D (Seal)
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Rev, 5/6/20