HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number :
L L Ll
L � � Building Permit Application
Planning and Development Services I
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 : Pcn cC i� 1CJ+ ' o n
PROPOSED IMPROVEMENT LOCATION :
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Address : 2
Property Tax I D # 16FZLN D ' L.l_,JV � � 1 Lot No ,,3 "- J
Site Plan Name : PN1YCrBlock Nh,__ _Cj �����
Project Name : _P _
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DETAILED DESCRIPTION OF WORK :
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New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION :
Additional work to be performed under this permit — check all that apply :
Mechanical GasTank _ Gas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq . Ft of Construction : _ Sq . Ft . of First Floor:
Cost of Construction : $ p1 �l K7 . � � Utilities : � Sewer _ Septic Building Height: _
OWN- ER/LESSEE : CONTRACTOR :
Name I / Name: run
I Address -. W h �.I"�'d � � n Company: c1c:
City : mj State : �, Add ress : � Q cloar
Zip Code : J '1 � F a x: �" City : 0 � :F
CA Stater
Phone No . C15 — 1 � 0(03 � Zip Code ,,., 3kA _qFax : --
E-Mail : f- -
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Fill in fee simple Title Holder on next page ( if i er E- Mail
from the Owner listed above) State or County License � � �-} 5m...
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.
SUPPLEM-ENTAL CONSTRUCTION LIEN LAW INFORMAT-1 -ON :
DESIGN ER/ ENG IN EER: Not Applicable MORTGAGE COMPANY; Not Applicable
Name : Name :
Address : Address :
City: State : City: State :
Zip : Phone Zip : Phone :
SEE SIMPLE TITLE HOLDER: Not Applicable 13ONDING COMPANY : Not Applicable
Name : Name -.
Address : Address:
City : city :
Zip ; Phone : Zi p : 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, 1 do hereby agree that 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and Sfi. Lucie County Amendments.
The following building permit applications are exempt from undergo ing a full concurrency rev iew: 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 youintend to obtain financing, consult
with fender or an attorney before commending work or recording Notice of Commencement .
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Signru-re of Owner/ essee/Contractor as ent for Owner Signature of contractor/License Hold r
STATE OF FLORID STATE OF FL
COUNTY OE5ilri
COUNTY OFgr G'
S rn to (or affirmed) and subscribed before me of Sw n to (or affirmed) and subscribed before me of
P sxGal Rr Bence or Or�line Notariza�Cion Ph , s�ca! Preser,ce Qr Dnline Notarization
'�h� 'daV of 20?�, by this ��day of � 202�by
GVff*% taNw-t ...LAb�
Name of P rson making statement . Name of pe son making statement.
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Personally Known 0 1� P�.���� ���i�t_ '�iR�a�f�y�.._.� Personally Known OR Pro��,s ���G����on
Type of Identification �.` � ••�ao-�s,o'���; v '� Type of Identification �����G�`.�;Mrssioy��
Produc d � :,is
`'+r ' 9 � Produ�� d .� g�,�Q c��;•,� ��
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gnature ofir Notary Public- 5t� ,�,�or�da } ,���:• �� (Signature of Notary Public- S�ate '�f, Fl� � I TA j� y i woo
41
Commission No. i�yt� 0A R�q����• `{ Commission No. �; . . . . . a�`����•
�lli1�l1l1t11 i /*V OF FLO
REVIEWS FRONT ZONING SU PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -----
DATE !
COMPLETED
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