HomeMy WebLinkAboutBuilding Permit Application All APPUCABLE O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services
Buiiding and Code Regulation Division Coi'i merCfai sidentiai
2300 Virginia Avenue Fort Pierce FL 34982
Phone: (772)462-1553 Pax:(772)462-1.578
PERMIT APPLICATION FOR:
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Andress: __
Property Tax Id#:
Site Plan Narrie:
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Project Name:
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New Electrical Meter � � __ �Second Eiectrlca?
Additional work to be performed under this permit-check all that apply,
,Mechanical Gas Tank teas Piping �Shutters Wi~:dows,'Docsr_,
Electric Plumbing � Sp6nkler, Generator __ '�oof
Total Sq. Ft of Construction: Sq, Ft. of F;r.st Floor
Cost of Construction: 5 ` �_� . _w .__. tlti;it;es, Sewry, _si.p,ir 'odd�,i I F
I Name ( �dCL1� Name:
Address: _ CorrrpaIzy. _ .._..._. _
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City: T 1oc- ,tdtc} Address: 6�
Zip coder _ . FaxCity: � � �.
Phone No. Zip Co, P:
E Mati S c ?/L ffi
�[ C4/r Phone No �
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Fill infee simple Title Holder onnext Pap ( if different v-i�1a11 3• �t _ .
from the Owner listed above) State or,County `icertsk'
if value of construction is 25C)0 or more,a RIvCORi7Ei3 No"t'ice cif Comme-ncement i, require+ .
if value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is tecluired.
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PCTION LIEN
DESIGNER/ENGINEER: _ Not Appi"cable MORYGAGE
COMPANY-Name:
Nam,>
Address: Address:
City:_.._,._.. _ __.State. City: _ _
Zip: Phone Zip: Fhcine,
FEE SIMPLE TITLE HOLDER: � Not Apjiiicabl BONDING-, COMPt1iNlY
jName: Narrii�:
1 Address: Address:
Cit •
Zip: .�Phone:______--_— ( ZIP.*--_.__.P1110rte:
_ ._.....
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby mace to obtain a permit io du w o c
I certify that no work or installation has corrimenced orior to the issuance of a permit.
St. Lucie County makes no representaCioo th",'it is gtaanljrig :3;x nmit wiii s utnure t) tile
which is in Conflict with any applicable Home Oviners Association rules, bylaws or and covenan C11, :
structure.Please Consult with'your Home Owners As:,ociation and,eview your deed for any re �:.`.,c;s �rt•c ;;;�.
In Consideration of the granting of this requested permit, I ao hereby agree that I will in<ill,espoc-,y, perf r rr
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Arnendri tints.
The following building permit applications are exempt from undergoing a full concurrerirv,re ifs.. roo n ;,i<illrt ,
accessory/structures, swimming pools, fences, Walt'::, 5tgn.s, screen rOC'.rn,and acM lessu, , its.othwr ri i 1
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying
improvements to your property. A Notice of Commencement Must he recorded in
Lucie County and posted on the jobsit;e before the first ;nspection. If you inters to ci,t -i
with lender or an attorney before c.ornmencinawork or rivccir din
Signature of Owner/Lessee/'Contractor as Agent for Owner signature or cnt ;i <ar/Lion'e folder
STATE OF FLORIDA STATE OF s LORIDA
I COUNTY OF _ COUNTY OFw _ .
Svtgrn to(or affirmed)and subscribe'-f before itie•of Sworn.o(i:r affirrrirzd}iir;ci',l,G7scrihtc 3c
X Physical PresenC or Online Notarization i Physical #%rear nee, or Onl- it
I thl>i �,?rsay a I L�._ w , d a20 by } this t ! ly as i
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Name of person making statement. Marne;.if pc rson rim,king +:-rnent
Personally known w OR Produced idlentiiicj ion Personally l<r own �. °'iY t'"rr=u.r d e-
i Type of Id e of cation — Type of idc.6fic<Ition
Produced _ ...\ Produced
(Sign tore of Notar blic- State of Florida __ ,_... ...._....__.. _ .._._.
;S+grettar€:taf No tar xlrlir :�st of
Commission No. Aoi
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ite of Florida t?rr7r ig$iiln IVC. le� Notary Public§tas a of Florida
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G 957803 : My Commission GG 957803
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REVIEWS i FRS ;PERVISOR PLANS L'f.GE AT!01 SEA P f�' rs _
'COUNTER ; REVIEW REVIEW REVZN RE'! L`'w iEV
DATE
RECEIVED i
y�C{O~M�PLETED A