HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE
7INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 2�2 Permit Number:
SC
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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: ,CY001'
PROPOSED IMPROVEMENT LOCATION:
Address: 000
Property Tax ID #:
Site Plan Name:
Project Name:
- 0 J0-0_592.-000 - 2-
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No. Z�-
Block No. 8_
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 Roofs Z Pitch
Total Sq. Ft of Construction: 1700 Sq. Ft. of First Floor: J 700
Cost of Construction: $ 1 Q I O(X• 00 Utilities: , Sewer Septic Building Height: G�.J
OWNER/LESSEE:
CONTRACTOR:
Name won
m am
Name:
\'
Address: 106o l V U CCQ D Y I V c1
Company: a Y
I V
City: lam' "� I C Y C State: k iC
Zip Code: 9 Fax:
Phone No.
Address: +Yl S
city � YC) ��a/1
Zip Code: _3ZC (Q g Fax:
Phone No Jr
E-Mail
State or County License
State:i
O 071
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
SURPLE ENTAL CONSTRUCTIO ,LIEN LAW INFORMATION.:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: ANot 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 'ounty 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF q �C�
Swor o (or affirmed) a d subscribed befQ;e me of Physical Presence or Online Notarization
this day of u I , 20 by
loan Skrq-la QVQ.
Name of person making state nt.
\/
Personally Known OR Produced Identification
Type of Identification Produced
(Signature %4.No Pub ic- to of Florida
_
Commission No. (Seal) o<.P!•"•r�,. KATHERINEHAVENS
_ MY COMMISSION #GG165030
*E� EXPIRES: DEC 04 $D
Bonded through 1st State Insurance
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