HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenge, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Resides
PERMIT APPLICATION FOR: cnc(
PROPOSED IMPROVEMENT LOCATION:
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tial
Address,• �`T nE
Property Tax I D #: Lot No.
Site Plan Name: Block No.
Project Name:�/{�j°� a�� "'�10�
DETAILED DESCRIPT10N OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATIONlk
:
Additional work to be performed under this permit — check all that apply:
Mechanical Gas Tank � Gas Pipi
� ng � Shutters
Electric
Plumbing
Total Sq. Ft of Construction.,di
Cost of Construction: $ C �2)(n , 0 (D
OWNER./LESSEE:
Name.b
Ad d res
City: �
Zip Coy
Phone
E-Mail:
F111'1'n fee simple Title Holder on ne
from the owner lisped above)
Sprinklers
16
G or
11 -r- 'F
iblE(�q U-sull
Windows/Doers Pond
... Roof Pilch
Sq. Ft. of First Floor;
Utilities. � Sewer � Septic Building Height:
xt page ( if different
CONT
Name:
Company:
Address:)
City: E5
Zip Code:
Phone
E-Maili' l'
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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,
Fax: d&-
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Stater
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SUPPLEMENTAL
DESIGNER/ENGINEER, N ot A p'p'l i ca b 1'e' MORTGAGE COMPANY, Not Applicabl
Name: 6
N m A
Address: Address.
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City: StatesCity: State:
Zi P: Phone Zi
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY, Not Applicable
Name; Name:
Address:
City: City:
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Zip; Phone:. Zip: Phone:
OWNER/ CONTRACTOR AFFDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 rues, 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.
Inconsideration 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.
AP
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 Nance 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 recordin our Notice of Commencement.
of Owner Lessee or�tr c r as Agent for Owner Signature of Contract-
Signatureor/License Holder
STATE OF FLORI A STATE OF FL D Jv*
COUNTY OFq,.,. ur,COUNTY OFILI. �
Sw rn to (or affirmed) and subscribed before me of two n to (or affirmed and subscribed before me of
Physical Presence or Online Notarization P
hysiea! Pr ence or Online NItarization
this dMOWay of Arw�0�., by phis � day of Q 20byA4 11-191-1
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Name of P rson making tatemer�t����OG0 �i��� Name of person making statement. >>\JJtMiilrJ//��
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Personably Known Q�c�;;������� Personally Known OR ��� ► Von!�� f,lType of Identification � .:� � d TA � Y qfi� • � Type of identification � �� ar-� .,
Produced � � + N; — Produced ;� � OTA R Y
U
8C��L� � ' � PUBLIC
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(Signature of Notary Public- Sty {Signature of Notary Public- Sta���� �fad���.��'��'��Commission N ��f �\��� ���r���OF FLIa FI�ov-
����� Commission No,, ►11081al�
REVIEWS FRONT ZONING SU PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVI EW REVIEW. REVIEW REVIEW REVIEW
DATA
RECEIVED
DATA
COMPLETED
Rev,,5/6/20