HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (Of 2S111 Permit Number: 410u.(0211
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Buil.ding
Permit A lication
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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: R300 W i NOi tJ L-IN ( L 1
Property Tax ID #: Lot No.
Site Plan Name: c� ` Block No.
Project Name:
DETAILED'DESCRIPTION OF WORK
New Electrical Meter Second Electrical Meter (Affidavit required)
['CONSTRUCTION,1 N FO R M ATlO'N - . ,.
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: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: L : �Y, ,;
CONTRACTOR:.
Name
Name:
Address: 9-300 ( d IL ]'N, Am CAUL bi
Company: A-sso ct 7 #94 yg o f r23e or
City: ala 2[ State: L
Address: ti550 5F PJ ( IFA,714 16A cl'e
Zip Code: 3 Yi S I Fax: *
City: C?C)r2k r i, U61k State: ! L-
Phone No. 772.,- 3-m `615l
Zip Code: 3 Vy 5 I- Fax: "[?Z
E-Mail:
Phone No '77 Z 335- 76 r,
Fill in fee simple Title Holder on next page ( if different
E-Mail_ _ Z {ASS OC..1_ 1'-}TE0:) 1301boulA, IU
from the Owner listed above)
State or County License P_ 2Z
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 IN;FtJRMATION
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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S r 4 u G ✓E'
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
thisda day of 7"AI X . 20,aL by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. J/ 69 ml1 6 5.r6 (Seal)
6AQJ�
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED
DATE
�" ONNotary Public Stale Florira
David Carl DeWitt
My Commission GG 2905.54
a � Expires 01/17/2023
S REVIEWOR I REVIEW PLANS I VREVIEWON I SEREV EWLE I MREVIEWVE