HomeMy WebLinkAboutpermit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SSA.LUU QL�
-�' 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 LOCATION:
Address:
Property Tax ID M: Lot No.
Site Plan Name: }} Block No.
Project Name: (Mb
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DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: 5q. Ft.of First Floor:
Cost of Construction:$ 2 ❑ _ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name;
Address: Company: F Mar
City: State& Address: IVanlz Mc, Sul'-�L
Zip Code:,—:240146 Fax: City: State:±L
Phone No. Zip Code: L;L. 114 Fax:
E-Mail Phone N❑
Fill in fee simple Title Haider on next page(If different E-
from the Owner listed above) Mail OfUS fj= r
State or County
License
If value of construction Is 2500 or more,a RECORDED Notice of Commencement Is required.
If value of HAVC Is$1,500 or more,a RECORDED Notice of Commencement Is required.
C _
DESIG ER I EI:R: ,Nat App ica le 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 AFFMVIT: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 Count make no representation that Is granting a Dermit will authorize the permit holder to build the subject structure
which Is In conflict wit any applicable Home Owners Associatlon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners AssocIatlon 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 your Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF cI 2+2 -c-
Sworn to(or affirmed a n subscribed before me of Physical Presence or Online Notarization
this PS day of 20,Lt by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced err
-Plbo�
(Signature of Notary Public-State of Florida)
Commission No. (Seal) E
PEDRO RAMELLO
Notary Public.State of Florida
Commission#HH 064189
My Comm.Expires Nov 16,2024
ded throw h National NotaryAssr+.
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