HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL IN 0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
17
Date: 1'✓V Permit Number:
r- L �, �' L L `? Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
Residential,
PERMIT APPLICATION FOR:
PROPOSED IMP OVEMENT LOCATION:
Address: C� ACID OTi1l qI Ads ?4qb7"_
Property Tax ID 0:
Site Plan Name:
Project Name:
Lot No.
Block No.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Ga Ta k Gas Piping — Shutters — Windows/Doors Pond
V Electrick"A _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r
Cost of Construction: $ 00 Utilities: —Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name PCs OrY`
Name:
114, Ids
Address: U
City: C.� Stater/
Zip Code: �q �i Fax:
oti,.no ni l d�_
Company:
Address:
(� SF OS �e_V6
City:
7i, r..,4..
Phone No
Stater
c
2"
E-Mail: 21<< b U% t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail (r
State or Co my 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, 2 RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 lender or an attorneyA before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STAC UTE OF NTY OFORIDAr L ��
STATE OF COUNTY OFORIDA' 1, ( U
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notariz
this 2* day of }j „ l83'V by
Z.z( A
�rtr �kQ_'
Sworn to (or affirmed) and subscribed before me of
Physical Pres or Online Notarization
this day of , tM7by
—Ze21
Personally Known OR Produced IdentificaType
Type of Identification
Name of person makingent. pii;i
Produced
Name of person making statement. i N
Personally Known OR Produced Identif a#
of Identification o. —
Produced v�.
(S gnature ot�a/ry Public- State co (Florida) ,
Commission No. t` 0b� /l (Seal)'
(Signature of,14 ary Public-Stateof Florida) •
��l 7�/ d
Commission No. f' (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.