HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Cl - t 2 J D 1 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial ✓ Residential
: PROPOSED IMPROVEMENT LOCATION:
Address: I L L'yy— 6 15-k-ca. 7�-,
Property Tax ID ##: �,la �,�db - C 1 1 G C% Lot No.
Site Plan Name: II S ": VkL%-1F- \7S u;hkBlock No.
Project Name: S .:,
DETAILED DESCRIPTION OF WORTS:
�' �- N
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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: $ 30 O ' G p Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE.
Q C NTRACTOR•
Name
Name:
Company:
Address:
,
alEt
Address: 111 a� t; \3 S a
City:_\/eState: (7-
Zip Code: C15� Fax:
city: 04{:;vr
State:�fr•-•
Phone No. rJ - L� i 7 - \25 y
Zip Code
Fax
E-Mail:
Phone No GY'
Fill in fee simple Title Holder on next page ( if
different
E-Mail .S'_
axno
from the Owner listed above)
State or County License
JH2% c"
- -- -•--••--• - •- •• •� +......„ -1 c, a nca-vnVGu IYULIGe oT l ommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
.RU0
DESIGNER ENGINEER:
Not Applicable
. .;.., ._. .
a" .
—
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
T
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 your Notice of Commencement.
Sig Lure of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of
20 Ac
by
Name oi person making statement.
Personally Known OR Produced Identification
Tyy{" Identification Produced
(Signature of Notary public- State of Florida )
Commission No.(Seal)
REVIEWS FRONT fII ZONING
COUNTER I REVIEW
RECEIVED
DATE
COMPLETED
oAlf 04 Notate Public State of Florida
Savitri Ramdiai
s My Commcssion GG 254615
Expires 091012022
SUPERVISOR I PLANS I VEGETATION I SEA TURTLE MANGROVE
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