HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: -
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V IL O E U D to = 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:q(fCC)S. .(.cectn� 1+Un' 1(�j(�4 ,J�(1�n 1 7 .t L C�. C
Property Tax ID#: �IlrCf` no-4 -( - C Lot No.
,Site Plan Name:EQCPfess Unl �DO—Z;L Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric V/_Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
,Cost of Construction: $ /,Ay b Cy Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name `�R� � l_)'RD
A �f_ e Name: nn\S
Address: S_ n Company: f72
City: �fl�n State:EL AddrP)-wa,
� � S1 �� .� 1 cle &0Zip Code: �GI 52 Fax: City: l �,lr\i Stater(
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Phone No. -7)-3'(nDD Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mailrh-) i_ C%Nut- r (��c kz,,C
from the Owner listed above) State or County License(l(Q_3p��)(D
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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0_ 1 MAN
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 su Ject 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 roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and poste on the jobsite before the first inspection. If you intend tain financing, consult
with lender or an a tgir a before comrnencin work or recor in our Notice mmencement.
SignaturCF
f O r/Le eeM
s Agent for Owner Signature of ntr for 'ce Holder
STATE ORID STA�£�OF FLORI
COUNTY F CQyNTY OF
Sworn to(or affirmed)and bscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Pres nce o Online Notarization
this day of y this day of ( 202,K by
Name of person making statement. Name of person making statement.
Personally Known 0 r u e Identification Personally Known /� OR Produced Identification
Type of Identification pe of Identification
Produced ��"" Notary Public State of Fbrida roduced
TRACY CARVALHO
My Commission GG 950192
OM Expires 03/22/2024
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(Signature of Notary Public-State of Florida Signat e��frdWataryQ14 biwrlg o a
_ TRACY CARVALHO
My Commission GG 950192
Commission No. (Seal) Commis ( al)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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