HomeMy WebLinkAboutBuilding permit appAll 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 Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1 ► r�S Ctr el,.e,r C-C' 3Lf C! SI
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
c G4n
TO ItJ
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
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
Total Sq. Ft of Construction:
Cost of Construction: $ � 1 4o . % !z
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
I OWNER/LESSEE: - I CONTRACTOR:
vC-0
Address: 1I lz�:�1/1:
City: -Pr , C �-CCk'- State: P�,,
Zip Code: S) Fax:
Phone No. f 1 S -gas - �C"s
E-Mail: r-),1 U 1'rr\r, r-11 rr')r,"\r.O - rr► (Y\
Fill in fee simple Title Holder on next)Mge (if different
from the Owner listed above)
Name: V i N t
Company: N,) C\%
Roof Pitch
Building Height:
t
Address: �-t �a 0 - �
City: V-731-1 State:i
Zip Code: Fax:S
Phone No �-�a 1
E-Mail OCr^
State or County License
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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_ Piease 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. IR a to obtain financing, consult
with lender or an attorney beforgifommencing work or recor " g ti of Commencement.
Signature of Owner/ Less t r as Agent for Owner
to ntractor/License Holder
STATE OF FLORI A
I STATE OF FLORIDA
COUNTY OF
COUNTY OF
5rvprn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thisak day of ¢T� Z020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this �� day of j2ha)C'C�� 2ON by
_o al
w
Name of person makings extent.
Name of person making statement
Personally Known• r
Type of ldentifiptiort ,r*Yr4� Notary Public State of Fior}da
Produced ^ Stacie Pagura
Commission CMG 15i33fi7
L Expires Q2102l2022
ersonally Known O�R�od�de iftca "
pe of identification
roduced Public State of Floriday
; cte Pagura
5 n y Comm ss�on GG 150367
Eapires M0 2-f2022
j
(Signature of Notary Public fate 6f Florida)
(Signature of Notary Pu lit; -
Commission No. 0 (Seal)
Commission Nome-.. ` Q 6l 7 (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
I VEGETATION
REVIEW
SEA TURTLE MANGROVE
REVIEW I REVIEW
DATE
RECEIVED
{ I
DATE
-[—
COMPLETED
ev. _.. �..