HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address: CX Jf
Property Tax ID #:
Site Plan Name:
Project Name: C
Commercial
DETAILED DESCRIPTION OF WORK:
011
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential `"
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 P't h
Total Sq. Ft of Construction:
Cost of Construction: $ n
, cc
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ticor
Name:
t
Address: 1
Company:
City: p _ Staten-
Zip Code: O Fax: —
Phone No. �� -
Address: C
City:
Zip Code:
Phone
1
State
x: -'-
N
T%Uicense
E-Mail:
Fill in fee simple Title Holder on next a Ii di erent
from the Owner listed above)
If valueof construction is 2SOn nr mnre n Qrrnoner, a�,..: _c
E-Mai
State or Coun
........c..� .o .c4ull Cu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
ri�n/RICQ/ /"�1NTOA/^TAn nr-�raan�-_ _
Zip: Phone:
--'-
..... ,-a,-
,y,„ , , „NN„cauvn is nereuy maae 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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 recording our Notice of Commencement.
Signature of Owner%Lessee/Contractor as
for Owner
STATE OF FLO
COUNTY OF
S iorn to (or affirmed) and subscribed before me of
Phy5ical Presence or Online Notarization
this _ffday of mft-0 202d-by
Name of pFrson making statement.
Personally Known �90 �,��I�I
OR Produr ii�Ajqn _
Type of Identification
Produc
a 0
_ : •L 4
(Signature of Notary Public- 5tlo I LIC
Commission No. 151617``(pCv1(o��'%,��yj
F FLO�`0���
Signature of Contractor/License Holder
STATE OF FLO I A
COUNTY OF MC,i-e.
Sw�rn to (or affirmed) and subscribed before me of
Ph 'cal Prwfnce or Online Notarization
this 2Z day of IJ�(� 20A by
Name of p rson making �rtatement.
Personally Known V! OR Produ,n
Type of Identification ���` N Al"-
Produced ��`� ��'.• issip•-.S
�� p
X F ��TgRYty
(Signature of Notary Public- Stai 4. qo�i IcAW L I C
Commission No. i,4)�•:.•op
6F FLOR�.��`�
"/01111 II101
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Rev. 5