HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V-1391 Permit Number:
SCr, Ll FLl �
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter
o��q�vvo-
Electrical Meter
Building Permit Application
Residential
3
Lot No.
Block No.
'414
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: $ V3 to - Utilities: -Sewer _ Septic Building Height:
Name
City: `r/iU Fir / State: f-L
Zip Code: 3 VV s ! Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: r1_(4 /'C'L
Company: ;
Address:
City: / ty State:
Zip Code: NO 1115Fax:
Phone No 7Z 3
E-Mail a dd le
State or County License do'?&
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.
14
LIM
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 lende or an attorrte before commencing work or recordip ou��lotice of Commencement.
Signature of OwnerJ'tes eeJContractor as Agent for Owner
Signature of,. C ntractor/License Holder
STATE OF FLORIDA // /
STATE OF FLORIDA � %n �W
COUNTY OF 7 o�.�G �
COUNTY OF C p �,L(�.I'
Sworn (or affirmed) and subscribed before me of
sical Prese ce or Online Notarization
Sworn (or affirmed) and subscribed before me of
Ph sical Presen or Online Notarization
this � day / 202V by
this d by
of
of �2A
C QP ,�
Name of pers
Name of person making st to
PATRICIAR. HILL
Personally K%p�gSll6otio
i;aY:e" PATRICIA R. HILL
Personally K orii *: ��ri
Type of [dent iT P ; EXPIRES: April 7, 2024
AP
Type of Ide o: EXPIRES: April 7, 2024
'•,'F
Produced Bonded Ttn P blicUnderwriters
Produced a?;` Underwriters
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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SUPERVISOR
PLANS
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DATE
RECEIVED
DATE
COMPLETED
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