HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION OR
Address: V 1-16/`1 D. L/ C Wr 1 1 o r
ii
Property Tax ID#: �� ! l� �3/,7 41 Lot No. :_:�7
Site Plan Name: �i Block No.
Project Name: a
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit — check all that apply:
V/_Mechanicai — 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: $ 51leo Utilities: _ Sewer _ Septic Building Height:
Name 'nstv Name: %J 'r1C_I V i v� 4CA�
Address': t7 r • Company: In A ! 1`
City: JI State: Fi, Address: fteCra r
Fax•7 2 396rq'72`? City: State:
Zip Code: .
Phone No. 7 --7- %25J Zip Code: Fax: ! 7Z' 2"9%G
E-Mail: ,Y1 Phone Nof7 0 30:6 7
Fill in fe imple Title Holder on next page (if different E-Mail
from the Owner listed above) State or C unty License
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.
q� d
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 W ao Lf,e wur K allu II zma11aNV , a�
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
structure. Please consult any
lome Owners Assrs ociation and rules,
ev ebylaws ur deed for any rents strictions strict ohat ns which may aprohibit such
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.
%i
Sig f Owr�,rf Lessee/Contractor as Agent for Owner I ainyeX Contractor/License
C'
STATE OF FLORIDA I STATE OF FLORID
COUNTY OF __,� I i i '' I-e COUNTY OF .._
Swor to (or affirmed) and subscribed before me of
P�ysical Pres"cel or Online Notarization
this 1 ✓ day of 2021 by
5,1W rl
Name of pers n maki7OR
tement.
Personally Known Produced Identification
Type of Identification
Produced
Swop to (or affirmed) and subscribed before me of
Physical Pretence or Online Notarization
this day of c .0 12021 by
Name of person mal ng s ement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi
(Signature of Notary Publi
�� Notary Pubbe Stave of Rands
N" Notary Public State of Florida
4' AN
Commission No.
• Crain A,Groaaman
fuly lsswn GG 983069
Expires 06/1012024
ommission No.
Cra{�, Rossman
' My Caa@mdalon GG 983069
Expires 05i10/2024
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