HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ?,l V&
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Building Permit Application
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Planning and Development Services
Building and Code Regulation Division Commercial Residential?
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (712)462-1578
PERMIT APPLICATION FOR: 2 q0 c Co
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PR{)POSEQ IMPFtOVEIUIENT �OCATIdN
Address: 66W e, I.?C,L, Wit- FL 34Q,5
Property Tax ID#:1301(c3C E`(j12q C=—3 Lot No.2q a. d
Site Plan Name: Block No.
Project Name:
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DETAILED DESCRtPTIUNFC}F WORK.,
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c� ( F u.Y V"e:�L Comet , 1,_ 12 X 12 T-":A w/
New Electrical Meter Second Electrical Meter (Affidavit required)
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CQNSTRUCTION INFORMATION:_,
Additional work to be performed, under this permit—check all that apply:
_Mecha.nical _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: $ q('no . Utilities: —Sewer _Septic Building Height:
OVIlNER/LESSEECCINTRACTaR
Name �,�,�,� Vnin �b1e Name
Address: (o(g00 'LQ, 1124Dt°Ia Company:
City: P044 .flll,_ure State: Address:
Zip Code: Fax: City: State:
Phone No. 32_IQ6I Zip Code: Fax:
E-Mail:re��vin)a�f,n�G�(.Q� �,�Mr��asT� 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.
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SUPPLEMENI' L CONSTR° 1CTCON LIEN US►1lV INtR'MATIOIVt "y'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 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 a-ttorney before commencing work or recording our Notice of Commencement.
Sign Eure of Owner/ ssee Contractor as Agent for Owner
STATE OF FLOR40A
COUNTY OF ��C,�, e
Swor o(or affirmed)and subscribed before me of Physical Presence or .Online Notarization
this day of 20'Li by
Name of person making statement.
Personally Known OR Produced Identification.
Type of Identification Produced c
(Signature of Notary Public-tAe of Florida)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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