HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: II I 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: C, Lijet 2 a( . ',Nge,r
PROPOSED IMPROVEMENT LOCATION: `-
Address: I oO% ee o 54- -evre e L 3ef I IS vim-
Property Tax I D#: 3 4 0 3- S w A n 00 A(-7 ^ GOO (e Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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I V1 0! l`S Y%A OWL_
New Electrical Meter Second Electrical Meter (Affidavit required)
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: Sq.
Sq. Ft.of First Floor:
�7 Cost of Construction:$ 01D.00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Clmde, Pi Name:
Address: O O S Company:
City:f 7+ �'1L,9i/`(A State:C( Address:
Zip Code:STq 'g Fax: City: State:
Phone No. - Sq Zip Code: Fax:
E-Mail: Fr 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.
tf die of H&VC is$7s'W or®area a RECOFA ED Nafte of Caoxnencenimt ii;i' '@4
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DESIGNER/ENGINEER: _jd:�'Not Applicable MORTGAGE COMPANY: V"Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: V*_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 concurrencV 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.
F
Sign'a'tu&of Owner/Less jreltontr r as Agent for Owner
STATE OF FLORID
COUNTY OF
Swor to(or affi ed)and subscribed before me of Physical Presence or Online Notarization
f this day o IJ14, 20PL by
Name of making
Personally Known � OR Produced Identification
Type of Id ntification Produced
(Signature;f Nota ublic-State of Florida Y
Commission No. (Seal) AUDREY B.HUMPHREY
MY COMMISSION#GG300817
EXPIRES:March 6,2023
Bonded Thru tiotary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I
DATE
COMPLETED
Llev 5/ 0121