HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U liiL �� Permit Number: )
L RECEIVED
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JUN 0 7 1011
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Building Permit Application
Permitting Depart ent
Planning and Development Services St.Lucie C ty
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:
PROPOSEQ IMPRQVEMENT LOCATlN
Address: �� ����
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Property Tax ID#:�_�=riG 3 "��9 � Lot No.
Site Plan Name: Block No.
Project Name: % �f�-C "�7✓ti
DETAILED DES CRIPT.ION OF WORK
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTIC►N INFORMATION
Additional work to be performed under this permit-check all that apply:
—Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors _Pond
4Electric V umbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft."of First Floor:
Cost of Construction: $ fy &VU Utilities: —Sewer "Septic' . Building Height:
77
OUtlNER/LESSEE . CONTtACTOR
Name
Address: �!o �4e_ eA�t - { Company:
City: r �. State:%L 'Addres
Zip Code: 3�Va Fax: ' " Citi �< Stater
Phone No. Zip Code: �,���3 Fax: 2 07
E-Mail: Phone NoG'-L%� 7s S
Fill in fee simple Title Holder on next page (if different E-Mail P
from the Owner listed above) State or County LicenseC
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 an applicable Home Owners Association y pp e rules, bylaws or and covenants that may restrict or prohibit such
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structure. Please consult with our Home Owners Association and review our deed for an restrictions which may apply.
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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
wi e dpf or an attorney before commencing work or recording our Notice of Commencement.
S ature wner/ essee/Contractor as gent for Owner
STATE OF FLORIDA °
COUNTY OF
Sworn to(or affir ) and subscribed before me of Physical Presence or Online Notarization
this day of 200*)1 by
Name of persorirmaking statement.
Personally Known OR Prothiced Identification
Type of Identification Produced
(Signature of Notary Publi tate of Flori a )
Commission No. (Seal) irsY?�°, AUDREYB.HUMPHREY
MY COMMISSION 0 GG 3508`17
€.:
- .�• •�o EXPIRES:March 6,2023
•�.FOFF�� Bonded lhru Notary Publio Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 20/21