HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFD MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-2553 Fax: (772) 462-2578
PERMIT APPLICATION FOR:
� PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #l: J`� — //�� —' r ��tt Lot No.
GW
Site Plan Name: � C�l� }�.� \ _.l' Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: R
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 Plumtb�ing Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: "tdcoi c_ Sq. Ft. of First Floor:
Cost of Construction: $ v i 0 (.) Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addre :
Company:
City:ROTstate:
cLu
Address: 3 by
Zip Code:� d Fax:
City:�] yrf
Stater
Phone No.
Zip Code- �a� Fax:
E-Mail:
Phone No CUCIA -N
Fill in fee simple Title Holder on next page ( if different
E-Mail—UUSQy bo
C, d iJ k
from the Owner listed above)
State or County License
3
ii value of construction is Z5a9 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
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 faiIV6 to Record a Notice of Commencement may r ult in paying twice for
improvements to your y. A Notice of Commencement must be r corded in the public records of St.
Lucie County and ed th jobsite before the first inspe u intend to obtain financing, consult
with lender or attor be re commencing work or r rding y Notice of Commencement.
Signature
ractor as Agent for Owner
or/License Holder
STATE OF-F"LORID STATE OF FLO
COUNTY OF 5e COUNTY OF �p f Z a—,=)"
w to (vr affirmed) and subscribed before me of 1s;
o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization sical Presence or Online Notarization
t is day of MaM�k ;-� by day of ( Eby
Name of periaking statement. Name of person making statement.
F
Identification - R/Persormlly Wows/- OR Produced Identification
ignature of
�1.
on
c- State of
Commission No,
Commission No.twll nAC`C'g0
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DATE
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DATE
COMPLETED