HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to Permit Number: ,tJ�G v�~�
S��C LUGClli
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578
PERMITAPPLICATION FOR:
PRCIP 'st '-IMPROVEMENT LO; -ATIQN
Address: vv1 SA L p F'T 10`'.e` ea., rL "4 l(9.5'./..
Property Tax I D#: 1�O I re16 6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCR[P§TIONF 1NORK
%o(" +5 .,ivq tiNle ev ` Me d `►JJP►V: 0P5
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
_Electric -Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ &y OO 00/P-&e Utilities: _Sewer' _Septic Building Height:
QU1/NER ,LESSEE CONTRACTOR
r n! s+ r "y ha
Name e U� L✓ C- boo SAL e -< Name:
Address: 7 10`? ( u 6V�OS�J �/y Company: .
City:p-o rT State: L Address:
Zip Code: 1 Fax: , City: State:
Phone No. (77d, ! �7 y ' 6;fl Zip Code: Fax:
E-Mail:�DU / /® V) f�2 t G 4-+,0410— 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.
SUI?PLE11/IENTALfCONSTRUCTION LIEN LAIN INFORMATION 3
a 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 theissuance 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 Associationla' cl 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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Ag nt for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirm ) and sljbscribed before me of Physical Presence or Online Notarization
this day of 20 by
Name of person making statement.
Personally Known OR Produced Id ntific
Type of Identification Produced
(Signature of Notary P
tp,PY pVB, ELLEN VA';GHN ,
Commission No. ;z° ` :State of��6f{ -Notary Public
_* *c Commission #1 GG 270079
R,
'9jFOF My Commission Expires
October 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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