HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
,COUNTY
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 4000-7 5 Y,,�l:etn_ k"/tc Zjc -t:,oc-f P;ctLe- . Ft 3Kqu;L
Property Tax ID #: 352`i - 231 - 6005 - 000 - � Lot No. —I
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
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
_ Electric — Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2-7 fr5
_ Generator
Block No.
'✓Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR;
Name l-uk4E- Akbbrt -- -
Address: tooco 5 iaaictr% L-c-
Name: f2-c�
Company:
City: Fo "-t P , t etc State: _FL
Zip Code: 34kls Fax:
Phone No. Sl+k - Sok- Q&C c
Address: -011 -5T
City: 4-z;�'L-if State:
Zip Code: _ S Fax:
Phone No �;6 j 74 74 5-
E-Mail: lu _ t�cc��bz�k � erAw�.Lc0Y.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 IPndpr nr an attnrnpv hpfnrp rnmmpnrino wnrk nr rprnrdinv vnur Nntirp of Commencement.
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4
Si a of Owner/ Lessee/Contractor as Agent for Owner
Signature of C ntractor/License Holder
STATE OF FLORIDA,,, i�t.'t p ��
STATE OF FLORIDA
. V-
COUNTY OF _
COUNTY OF -
Sworn to (or affirmed) and subscribed before me of
Swop to (or affirmed) and subscribed before me of
�✓ hysical Pres c o Online Notarization
this day of �029"by
✓Physical Prese-r�ce or Online Notarization
this - day of r' ` 2G2e by
2�2I
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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
(Signature of Notary Publi a e o orl a
.Y ' c; Nolary blic State Florida
(Signature of Notary Public- ttior' }}
W Pubbc State of Flonda
or
Lero�yyt� �Stove!
Commission No. �4- Az' % My(0&8I>lission GG 20658t
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. Leroy N Stove[
ommission No.Gdr ,ET e1 On GG 2065a4
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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