HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE I O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `3 tea- Permit Number:
DD 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:
PROPOSED,IMPROVEMENT.LOCATION:
Address:
Property Tax ID#: \AS \a 1 00 S1A Lot No.
Site Plan Name: Block No.
Project Name: Qn—* 0
-DETAILEDDESCRIPTION';OF WORK;
-1TP—a
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:$ S70 Utilities: —Sewer _Septic Building Height:
:OWNER/LESSEE:., ;' . ::CONTRACTOR:
Name���1 .c . ._ . �� ��.. Name:
Address: \\1,3Qb 5,' Va\\ Company: U • er c`,L\, Y'11A\"a 1111zz
City: Stat Address: �SW
Zip Code: Fax: City: (ESL Stater
Phone No. Zip Code: `31�� Fax:
E-Mail: Phone No`°1 �,
Fill in fee simple Title Holder on next page if different E-Mail qJ SL� 1— 2- &"'U
from the Owner listed above) State or County License cju'\Si3 N�
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.
17
:`SUPPLEMENTAL- CONSTRUCTION LIEN LAW INFORMATI01
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.
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 lender or an attorney before commencing work or recor ' of Commencement.'
,
Sig ture of Ow'ner/-Eess s Agent for Owner Sig atur Contractor/License Holder
STATE OF FLOR14A ST OF FL IDA ` mac 1
COUNTY OF )r Lure COON F
Swo n to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization -�Phy`sical Presence or Online Notarization
this 4 day of I� Xy- 2020 by this�day of 202P by
Name of person making
statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identi 'cation Type of Identificat' /
Produced Producedji
W
(Signat re of Notary Public- a ]19m ry Public-State of F 0,194 ature of Notary Public-Stat Florida)
'• • Commission#GG 307829
+�oFF� Commission Expi a " � 4EEW
l)GHN Commission No. d �� �.` (S�aY) ,tune 22, 2023 Leo ission No, =2�PaYP° otary PublicG 270079' "11\�ew XpIfBSREVIEWS FRONT ZONING SUPERVISOR PLANS VEGE o E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIE
DATE
RECEIVED
DATE
COMPLETED
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