HomeMy WebLinkAboutBuilding Permit Application , UPDATED TO OWNER BUILDER All PLICABLE INFO MUST BE OMPLETED FOR ARtWATION TO BE ACCEPTED
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° 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 w� (�� � � -��alb
PROPOSED IMPROVEMENT LOCATION:
Address: MORI (3lS L.enc- Pine- Dr. rar-E- Pt Ar'[e , FL- 94 992
Property Tax ID#: 3�{09 - SOS- OU Zoo^0 00_2 Lot No. Z I
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:'
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New Electrical Meter Second Electrical Meter
CONSTRUCTION I NFORMATION:
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:$ 572/1000* ef� Utilities: _Sewer —Septic Building Height:
,OWNER/LESSEE: CONTRACTOR:
Name IA;(iic-M TiIIbeo Name:
Address:1313 Lent Fir !e, n,r. Company:
City: For+ R uc.,-_ State: FL Address:
Zip Code: 349 it z Fax: City: o _ ,. Stater
Phone No. Zip Code:
E-Mail: Phone
Fill in fee simple Title Holder on next page(if different E-Mail_
from the Owner listed above) State or County License R'_ _ -—
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.
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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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .DOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOU DER OR A TTORNEY BEFORE RECORDING,YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OFORIDAFLORIDA
S 1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of-`1Al 2q by this day of 20_ by
Name of IYerson making statement. V
I Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced �-- ®� Produced
(Signature of Notary Pu ic-State of FI_LEN V Notary Public-State of Florida )
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Commission No. (-r�7(�[TI :" r'r` sstnn G°r6otary_pi,�I' No. (Seal)
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October 2 2Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
eV. 4PRY P(B '
;=o � State of Florida-Notary Public
•_ Commission # GG 270079
My Commission Expires
October 22, 2022