HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:21 Permit Number:
vi, 41 Building Permit Application
Planning and Development Services
Building ndCodeRegulation Division Commercial Residential
2300 Vir inia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: ,�'1��-`lam - lJ -y 1 Lot No.
Site Plan Name: Block No.
Project Name:,
DETAILED DESCRIPTION OF WORK: - — -
X �A �%l 5 �1✓t c� � �/
New Electrical Meter Second Electrical Meter
CO RUCTION 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: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t' `_k � ' -- x
Name:
_
Address: YN-ICA G`rs1C` �
Company"�
City: -e rc9- State:
Address: el bad' �y c-4-
City: `- State:
Zip Code:Fax�:l,
Phone No.SZ
Zip Code: Fax:
Phone No�11
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail -Lc. �� SefV� c7 C {,-
from the Owner listed above)
State dr C unty 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.
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
State:
City: State: City:
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
rules,
Associationalprohibit such
ev your deed any wh ch rmaor
structure. Please consult withyourOwners Assoc Association ew for restrictions
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
A Notice of Commencement must be recorded in the public records of St.
improvements to your property.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorneybefore commencin work or recording our Notice of Commencement.
en
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO�IQA
STATE OF FLORIDA
COUNTY OF �
COUNTY OF "``�-�.
Sworn to (or affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day day of �L.�-�� , �C by
Physical Presence or Online Notarization
this 3C� day of �-�-Y�•G .�� by
Name of person making statement.
Name o� making statement.
Personal�yl< nersonally
Known
��NotaryPublicState of FloridaY-tdentifiicationoNotary
ntification
Pubbc Stafeofflaitla
Ashley Del Toro
Produced
Produced Ashle Del Toro
rssiat HH 052369
Expires 10l11R024
Y ommisswn HH 052369
A i Aim^d� Expires 10/11/2021
,A
(Signature of Notary Public- State of Florida)
(Signature of Notary ublic- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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