HomeMy WebLinkAboutbUILDING PERMIT APPLICATION AND DRAWINGAll 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 FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 10 BO, --T-w 14TDO ,\ '_Z) r � J " r l k . 1 _5`A CV-01
Property Tax ID #:
Site Plan Name:
Project Name:
f DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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: $ I c1
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: _ ,`
Name P t S , L_LC-
Name:
` .W ^_
Address: Q `
City: ae 0 State: t=�l-
Zip Code: Fax:
-r-
Phone No.
Company:
V r _
Address:=—� e� 1r?
nAyN iA4-e.
City: 7e r -4 _`�c��n �Acy
Zip Code: ,3`Ae'i 7 3
Phone No I 19� - L
E-Mail
Pl State: F-L_
Fax:
E-Mail:----
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
e 13 o 0,7 9 I D
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.
Name: — ..
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFiDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 rubs, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne 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�atlerney before corrigaencing work or recording your Notice of Commencement.
STATE OF FLORIDA
COUNTY OF
Sworn to for affirmed) and subscribed before me of X Physical Presence or Online Notarization
thisLdayof�v�,c. �Oaby
Name of person makifig statement.
Personally Known X OR Produced Identification
Typ of Identification Produced
(Signature of Notary Public- State of Florida } dry`
MY COMMISSION # GG 197659
Commission No. / 276 5 9 (Seal) ;;� 0;7` EXliRES: March 19, 20?2
c� „;,,• 5W4W Thu Notvyr Pd* tfid&*Aere
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER I REVIEW REVIEW REVIEW REVIEW I REVIEW I REVIEW
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