HomeMy WebLinkAboutBuilding Permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1)/f l Z ( Permit Number:
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: i
Address: S6,10i iTlIrG; `U/ f /1" P/Cr
Property Tax ID#: Jy 0,2 60q Ol -7 0 QO :2 Lot No T FfC, T7
Site Plan Name: (-z t- Black No. fC
Project Name:
DETAILED DESCRIPTION OF WORK:
2S0 No/f4
4 IC-1
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 _ Windows/Doors — Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ra 4 °• a o
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C*le'l-e/ Col-,
Name: fC_,aldf
Company: fIc} /-Pr, c. nj
Address: 1 /r V,J1z 0,-
City: State: F�
Zip Code: 3 Y l/ f _ Fax:
Phone No 7 D Z d`7 `/ 37 7J
Address: T(01 13.1'c 1
City: F-i lee/Gr State:
Zip Code:T (/ 9�2 Fax:
Phone No 7`% f- rZ 8 20 74/
E-Mail: dcj.L_ i<r tio'l i,- C. U 6
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail , c l C ..t
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
IGNER/ENGINEER: ` Not Applicable
Name:
Address:
City= State:
Zip: Phone
FEE SIMPLE TITLE BOLDER: , Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: w Not Applicable
Name -
Address:
City: State- _
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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.
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
Swprn to (or affirmed) and subscribed before me of
_fN P ysical Prese ce or Online Notarization
this day of -292(rby
person making
Personally Known `z OR Produced Identification
Tyne of Identification
-r N tary PuD6c - State Of FlOndr
.� ommrssi0n GG 937394
Commission No. y (O$l�;res Dec S. 7973
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA 3p.-
COLINTYOF L C I �
5wo to (or affirmed) and subscribed before me of
VK
ation
{tw
Name of personmaking statement.
Personally Known V OR Produced Identification
Type of Identification
i� aiure OT Not Public St1tq da J DANIELLE 6-, JEWELL
Notary Public - State of FIOrk
Z o ssron k GG 937394
Commission No. a ++CC {rye
��. Expires Dec 5, 2e2
SUPERVISOR I PLANS I VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW