HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential �•f
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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M R( 1lIr TENT LOCATION,
Address: 600
Property Tax ID#: _3 09' -0 Lot No.
Site Plan Name: s Block No. 54
Project Name:
WWI
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New Electrical Meter Second Electrical Meter
MINI
WHIM"x °• �. ,� ,
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Additional work to be performed under this permit-check all that apply: — —
J_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: $ '`C Utilities: —Sewer _Septic Building Height:
tNTRACTQR: .. � . .;
Name I bad 41 Dlwul -f, �SI/Vlc-��l _ Name:v .
Address G,Lin C Company'.
City: t 1 C� State Address: r
Zip Code: Fax-777 �YJ� 1�2� City: � e State: �r�
Phone Now 2 �3 � Zip Code: Fax�77 9%� q ?Z
E-Mail: t Phone No 2���
Fill in fe simple Title Holder on next page J(if different E-Mail DSSf'V1Ql/I f7 Q �'
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
if value of HAVC is 57,500 or more,a RECORDED Notice of Commencement is required.
v.�xYx x, AYH x x
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _ Not 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 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.
Si f Owtr Lessee/Contractor as Agent for Owner naxnye /Copt ac or/license Holder
STATE OF FLORID I STATE OF FLORIDA
COUNTY OF COUNTY tt t br
Swop to(or affirmed)and subscribed before me of Swo to(or affirmed)and subscribed before me of
./ Physical Preece or Online Notarization Physical Pres nce or Online Notarization
this f day of 202� by this�day of 202t, by
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced 9,
(Signature of Notary Publi lommission
Signature of Notary Publi
Notary Pubk Stale of Flonds 7�`ZJN
Notary Public State of Ftonda
Commission No. Crap A1GrossmanCra ossman
'sa�on GG e83oes No. Mir imm; sw GG s�o6o
a �Hes 06/1012024
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.