HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB E 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Md
PROPOSED IMPROVEMENT LOCATION'Iffl- Ik "�WI ens
Residential
AddressC►e- �� -a7 �:V4
Property Tax ID#:_�3Z� �Sl�`- t'�J��p--i"��C> s i Lot No.
Site Plan Name:
Project Name: C u C ,-\ V-Y--\ \ t �e f-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Shutters 1�Vindows/Doors
_Mechanical _ Gas Tank —Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Block No.
Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ - Uy Utilities
Address -� ?S6 V� -I
City: N�' State:C-A
Zip Code: a)Acll� u Fax:
Phone No�1Z•
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sewer _ Septic Building Height:
Name:_\�_�,�n
Company=. t
Address: `��12c� OL_.
City: Q`J �- State:
Zip Code: _ LAL AC tP Fax:
Phone Nor12 •
E-Mail k cLic..--6A-c_,.42 ✓ Se �v � u2� Lx �'L4� i C
State o-FCodnty Li
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.
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DESIGNER/ENGINEER:
Not A licable
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.,
MORTGAGE COMPA
... ...
Not Applicable
Name:
Name:
Address:
Address
City:
State:
C'
State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE
TITLE HOLDER: _
Ngt- plicable
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 lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLO DA STATE OF FLORIDA
COUNTY OF � C_ t'_ COUNTY OF `fit- l .viLLf�
Worn to (or affirmed) and subscribed before me of
7� Physical Presence or Online Notarization
this? day of �r17 J,9'26 by
., -7.D L
Name of person making statement.
Pgcsefally Known
Type of Identificatio ' r,w lyotary Public State of Ftorute
Produced' r A hl 1 Toro
My cornmission HH 052360
11 „ Expires 10/11/2024
(SignaTure of Notary Public- State of FTot icTa
Commission No. (Seal)
Svyorn to (or affirmed) and subscribed before me of
P ysical Presence or Online Notarization
��
this day of by
Name of person making statement.
e�P rsonally Kn � �vp � -
-Type �,�* ►�y_ Notary Public State of F
Produced � Ashley pet Tao
omm�ssion HH OS
( q�d� Expires 10/tt/202�
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
tong;
2369
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED