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HomeMy WebLinkAboutBLD Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Lt LLLr
b,
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:eedqx--�- ( ")" / i--lle�
Address:
Property Tax ID I
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter.
Lot No.
Block No.
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:JQ� . Sq. Ft. of First Floor:
Cost of Construction: $ `tom, C(90 00 Utilities: —Sewer _ Septic Building Height:
Name —pe-.i Name: Ct -�-
Address: (Cep Company:
City: t''�d'�1'� [tea' _ State: Address: � LTe Y
Zip Code Fax: City: C`7 �- Stater
Phone No. �_ �bfra `7 Zip Code:3io t Fax:
E-Mail: eru&il (��' l}Ct p dL Ln Phone No .7 2C - f 16
Fill in fee simple Title Holder on next page ( if different E-Mail P1z) e s(, 1
from the Owner listed above) State or County License SC Ci
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
Naine:
Address:
City: —
Zip:
1
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
— Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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.
Wcie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
With Ipnrlpr nr an attnrnpv hpfnrp rnmmpncine work or recording vour Notice of Commencement.
43
CA,
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Cont or Licens Hol er
STATE OF FLOR,),DA
'-IAA-'
STATE OF FLORIDA
G11,fV1_IA/
COUNTY OF VV
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Swo or affirmed) and subscribed before me of
---PF`ysical Presence or Online Notarization
Physical Presence or Online Notarization
this 10 day of 0-yVeX� z@2rby
this _M� day of __A-Mf� 204 by
/7 nZ t
�
Name of person making statement.
Name o person making statement.
.
Personally Known �/ _ OR Produced Identification
Personally Known OR Produced Identification
—{
Type of Identification
Type of Identification
Produce _
Produced
r C
ol
ig ure f otary Public- State of Florida)
(Sign of Notary Public- Stat i a �{ptafyPut>ricStartof F
"� $
'Todd T Jackson
Commission No. ©} 3 C a4yCo+mn*sion () 3
Expires 11114=24
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5tom 'ssion No.t'`r �S � ( (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20