HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
9 Permit Number:
�V. u 1 0(7�'
. . . . . . . . . . . . .
IV
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
I PERMIT APPLICATION FOR: A/C C'v-�CC' .. .. . . . . - e-
Address: k L Act
Property Tax ID #: c:)OLL Oct,) G Lot No. � � '
Site Plan Name:
Block No.
Project Narne:_
A-
L\X1 ')- I a_
New Electrical Meter t s Second Electrical Meter
(Affidavit required)
Additiq al,
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: $ tr�g <1) Ir I Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACT OR::,
Nam (_'kar-i A-Y-'n Lr, L%,
Address: 14117
Name:
Company,
City: State:;-Address(=�7)
Zip Code: a Fax:
Phone No
City: Ar State:
Zip Code:,,`?`)L1'9_1A/ Fax:' i,,--
Phone No 61,11
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
State or County License CA, _I �;51 L"
it value or consirucxion is z.,3uu or more, a KtLUKUtU 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: p 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 attorney before commencing work or recording our Notice of Commencement.
M.
Signature of Ow or/ Lessee/Contractor as Agent for Owner
STATE OF FL V �RIDA
COUNTY OF ` $
Sworn to (or affirmed)and subscribed before me of i *Physical Presence or Online Notarization
this V day oft,",L r °4fi" ._.___ 20:."`) by
Name of person making statement.
Personally Known C' -OR Produced Identification
Type of,.Identification;Produced
(Signature of Notary Public- State of Florida )
KONNI LENAE DEWIn
Commission No. CIII.-r i„ ,i°t ,I � (Seal) _�� „::. NotaTYNblic—stateotFlo, a
t GG 166912021
* • Commission
° Ex Tres Dec 1Q
��*a Comm. p
tillll
Bonded lhrrn gh National Notary Assn.
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