HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: o(ol
Date:
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:
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PROPOSED IMPROVEMENT LOCATION:
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Address: �o�%
oTl 1 fit' ti� o tT u�� rt- d 9jz�
Property Tax ID #: •3_u/ -5®�- op.�3� d gO—� Lot No.
Site Plan Name: ski r LhWC-S D/ 45F-g Block No.
Project Name: S'Z/ �&6V lTS
DETAILED DESCRIPTION OF WDRK
ti�7� �Onl,i ll Girl A� C-u!5T ItoU fF t
New Electrical Meter
Second Electrical Meter
CONSTRUCTION .I NFORM'ATIO,N:.,
Additional work to be performed
/Mechanical Gas Tank
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under this permit — check all that apply:
—Gas Piping
_Electric _ Plumbing Q Sprinklers
Total Sq. Ft of Construction: 7
Cost of Construction: $ yu, 29 U
_ Shutters _✓Windows/Doors _ Pond
_ Generator ✓ Roof `� ,Z. Pitch
Sq. Ft. of First Floor: 9Jd
tilities: —Sewer KSeptic Building Height:
`OOWN,�ERJLESSEE: .
'Name) sZ.�N KOVI S T2u5fel� Or VfI&, u Szry�/w
Address: S�420 AI-
City: l WIC-�AQqi',+ State:rt,
Zip Code: 33yv Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
„ome: C4
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Company: C2rse Bu / wai
Address: sow
City: �%eJ �S% , l� State:
Zip Code: S _ Fax.
Phone No 7La) 2 P -q,3 QU 21j0 -q,? ,??
E-Mail AA5 6WSOUN , NET
State or County License
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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-SUPPLEMENTAL CONSTxRUCT,ION LIEN LAW INFORMATIQN t u >
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: 5TfVE ti6 Z6
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 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 our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of/Co ntra ctor/ Lice n se Holder
STATE
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COUNTY OSTATE OF F �-r �G�C
COUNTOY OFORIDAC�)
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
7L Physical Presence or Online Notarization
>G Physical Presence or Online Notarization
this TIn day of ��'%Z 202Tby
this - `bL day of �� , 20� by
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Name of person making statement.
Name of person maki g statement.
Personally Known OR Produced Identification
Personally Known >e OR Produced Identification
Type of Identificatior-�
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Type of Identification
Produced
Produced
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