HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ 41zl (Zf Permit Number:
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ICD 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 tMPi20VEME,NT LOCAT,[QN:
Address: NbrltS g1v0
Property Tax ID#: u602.•-aot.07.Kot Wo,S Lot No.
Site Plan Name: �lo 4L.1fl Block No.
Project Name:
New Electrical Meter Second Electrical Meter
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 _ Roof Pitch
Total Sq. Ft of Construction:
i s
Cost of Construction: $ ,
Sq. Ft. of First Floor:
Utilities: -Sewer _Septic Building Height:
OWNERAESSEE; :`..
CONT-RAC-TOR..
Name 4;0
Name:
Address: SH 1.1&r*k-5 6(vo
Company::52t . eaa.1-(
C.,rE.s� gut
City: ��tN�h+ 1� a e`a+� State: rl—
Zip Code: 34g57 Fax:
Phone No.
Address: -J4 Z 51 C+b4e A*�— Io r
city:?,J,
Zip Code: 34493
Phone No 172- 310-
State:
Fax: 77Z
Z43'1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MaiI 30r ifnLAb) 50o4V
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State or County License GGc.
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IT value at construction is Z500 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.
SUPPLEMENTAI,�CONSTI
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UEN 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 contlict with any applicable Home Owners Association rules, bylaws or and covenants that mayhirestrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions wch 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 rqcording your Notice of Commencement.
Signature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
X Physical Presence or_Online Notarization
thick day of A r,l 2021 by
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produce
Produced
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(Signature of Notary Public- State of fiori¢� 0 '�o,'�m'•
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