HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Lip ?2144 #.; t
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Residential
Address: 3ZI 21�t2� c`-f h ►y— ��,, ,(
Property Tax ID #: 2g30 ` 5�22' + . ffw - Cat No. -4
Site Plan Name: Block No.
Project Name: ', �1`i``���&Co
i DETAILED DESCRIPTION OF WORM: 1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows oors _ Pond
Electric Plumbing J;_ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: � ��lt� Sq. Ft. of First Floor:
99
Cost of Construction: $ 16�1 1110 Utilities:. _ Sewer _Septic Building Height:
OWNERJLESSEE:
CONTRACTOR:
Name
Address:
City: &Z State. _
Zip Code:_ Fax:
Phone No.
Name:
Company: C
Address: / 55? JG S , /U/
�L
City: �_T _T >�1 f� 'lf�
Zip Code: ,;1- Fax:
Phone Nov
State:
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License O&IC13,
J&;7-
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
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.
A;*- X44-
4�_K:: � �
Sinature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA���
COUNTY OF �f/�e/
COUNTY OF
Swor or affirmed and subscribed before me of
Sworn or affirmed) and subscribed before me of
ill Prese or Online Notarization
his ay of 262� by
hysical Prese or Online Notarization
this day of 202jb by
1111 CrJ Clt�� ��VP172)Q
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Name of person making statement.
Name of person making statem
Personals Known OR Produced Identification
Personally Known Produced Identification
Type Ide tificatio
Type of Ide cation
Prod ced
Produc
(Signat-re7of Notar Pu sic- State of Florida)
(Signature of otary Pub ' - State of Florida
Commission No. p�' �� °f F�
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Notary Public State of Florida
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