HomeMy WebLinkAboutBuilding Permit Application ' Ali APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: FC Permit Number:
Y - C6
��v*9-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 i�MPROUEMENT lOCAT[Q ;
Address: 1 c>t oc FL 6 ck
Property Tax ID#: %) Lot No.
Site Plan Name: Block No.
Project Name:
I DEEROW I 1111E R(PTION OF WORK;
C-V\Ouco u r`a -T U b 4c)
New Electrical Meter Second Electrical Meter
CON'STRUCTiaN I�NFORMMAIN
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: Sq. Ft. of First Floor:
o co
Cost of Construction L, t QD, Utilities: —Sewer _Septic Building Height:
OWNER/LE?S�aEE: CONTRACTOR:
Name 4�cx y1n��Q4 (A��,r�� Name: �v� go
Address: .' WQ1.! Company:
City: ��n- S State: Address:
Zip Code:3+--tL�9. Fax: City: State:
Phone No. �-? ?--�J21-1 ,-73`j L, Zip Code: Fax:
E-Mail: e--LAx)r--k6 l 2.(0Z—Q a wetJ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
=: '
. - P'NE
DESIGR/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 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
im �rovements to your property. A Notice of Commencement must be recorded in the public records of St.
Lu ie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
w' h lender or an attorney before commencing work or recording our Notice of Commencement.
Si nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
S ATE OF FLORIDAkj STATE OF FLORIDA
COUNTY OF LA (�{x COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this W of n A -4, 2 by this day of 21_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary u I' 41% Y, lorida LLEN VAUGHN ignature of Notary Public-State of Florida)
`;state of Florida-Notary Pub is
'' '= ssion # GG 27
Commission No. = o; ,�$�) 007 mmission No. (Seal)
11 opFS'C' R4 I-Ommission Expires
/lilt October 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.