HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 �� 2,1Permit 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:
Address: s4 �T 04•eg..-7 =/ / i e✓ to 0 r/ I ?,' U -A: � _-L,5
Property Tax ID #: > O — �50d 3 — 000 Q Lot No.
Site Plan Name: Block No.
Project Name: e)r;'r
New Electrical Meter Second Electrical Meter
Additional work to be performed
Mechanical Gas Tan
under this permit -- check all that apply:
k —Gas Piping (Shutters _ Windows/Doors _ Pond
_ Electric — Plumbing T Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / g Utilities: _ Sewer ^ Septic Building Height:
Name_ G� h _ V,4or;e,
Name: fn 'e
Address: y Pr_n,_e
Company: Cpg1f„l C/J
Address: 9.2 36 or/ Lac: e avt%
City: �� �`c✓rrT _ _ Stater
City: 'ri/G State: C/
Zip Code: _ i3 Vi 3,2 Fax: ti,.4
Phone No. 77.2 • o? O �_//_ _9 0
Zip Code: a U j!Y - Fax: 71?- ,VO 1-,Ofj—.r
E-Mail: N-
Phone No 77?-
E-Mail TO Q X00o. i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License e J s/J-04F
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.
`1%04v16F%/ __,XNot Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: �( Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
up:, Phone:
..X Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 lender or an attorney before co
mmencin work or recordingyour Notice of Commencement.
1
r as Agent for Owner
STATE OF FLORIDA
COUNTY OF!
Sworn to (or affirmed) and subscribed before me of
[-Ply sical Presence or Online Notarization
this 2f7_clay of A ZL,NM by
Zoe
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produce Srt� CA t
f
i ature of Notary..Ru'bI1 - State o rida )
Of
STATE OF FLORID
COUNTY QF �,r act C
Sworn (or affirmed) and subscribed before me of
' Physical Presence or Online Notarization
this Z5 day of b L -2QW by
Name of person making statement
Personally Known OR Produced Identification L_--�
Type of IdenX cation
Produce tAa -k A Dukk� U�
(S. ure o otary bl - Eorida )
Commission No. �$eat)(1VA CuEz Commission No.
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