HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE (INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �J 2� Permit Number:
LC L CC"IE -
U L @', c<: ° G, 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 LO ATION:
Address: if) 0C-70A) C
Property Tax ID#: % S12 90 Lot No.
Site Plan Name: Block No.
Project Name: 9- P�! C '1
D TAILED DESCRIPTION OF WORK:
4X z7 dz'V
S vas
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _4indows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWN SSEE: CONTRACTOR:
Name Name:
Addres : 1 y Company:
City: cJ l'GG Stat dr es . -/t`
Zip Code: 7 Fax: city: State`
Phone No. 211- 23 Zip Code V910, Fax:
E-Mail: Phone No 27
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License Z
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.
SUPPLEMENTAL CONSTRUCTION LIEN 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 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.
Lucie5pu and on the jobsite before the first inspection. If you intend to obtain financing, consult
with lenders attorn bejDfe-commencing work or recordi ur otic of Commencement.
O
fgnature f Own es e/Contractor as Agent for Owner gnature of Contrafor/Licens Holder
STATE OF FLO A / STATE OF FLOR A L
COUNTY OF //L�i'T/i'1 I N c i COUNTY OF
S rn to(or affirmed)and subscribed before me of S or to(or affirmed)and subscribed before me of l CC
_ F c
Ph sical Presence or Online Notarizatfor>_ J hysical Presencepr Online Notarizatiorj
this day of -�Bz6 by this day of -2929—by
Name of person making st teme t. I V y (' Name of person making statem t.
Personal) Known OR Produced Identificatlori Persona y Known OR Produced Identification
Type of I entification "` T e f entificatfon
1 (
Prod c —G � - Pro d
/912
(Signature of Notary Public-Sta o lorida ) (Signature of Notary Public-Sta of lorida )
Commission No. `tSeal� T F N (Seal)
IPLISSBAUMGARTEN COmIY11S510f1`N0
Notary Pihhc st?tc of i wib 1 Plotary F'Llh st of lunch I;I't
11 GG 311d12 ,��. � - rt i.•.inn'1 G(. 11 I^•'1Z
gar 11 _(12 t i�
0 1hy Con ill.E ni �'� ' fAy Comm E:nil
REVIEWS FRONT ONING�th 5LIPERV(SOf�_" PLANS VEGETATION iii15EA4TU`R LE MANGROVE
COUNTER -REVIEW--"- REVIEW REVIEW '` `'REVIEVI/ REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.