HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —/- let - 2 Permit Number: _
97�on�U
Q ,10' U 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: IN
P.ROPOSfD IMPROVEMENT LO=CAT.IN
Address: as IULN�
Property Tax ID #:
Site Plan Name:
Project Name:
RETAILED DESCRI PT I O.N:O F WORK:
-:!�l<� V
New Electrical Meter Second Electrical Meter, (Affidavit required)
CONSTRUCTION' :INFORMATION
l o l 1--6r) a -
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
Mechanical —Gas Tank _Gas Piping Shutters Windows/Doors ,Pond
1 b' Sprinklers Generator Roof Pitch
_ Electric ^ P um ing
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:
_Sewer _Septic
CO:NTRACTOV'
OW.N:ER/LESSEE:
N MeAi2 �•
XVQ
Name: � � f� Q
Address: -f I.p
Company: ~'
City: ` 011 State:
Address: —SE
Zip Code: 9 Z _ Fax:
City:
2- 0 C9
Zip Code: Z-
Phone No.
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail 0
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 $7,500 or more, a RECORDED Notice of Commencement is required.
Building Height:
1 ePa
i-UeA
-e_ State: -El
Fax:r" d
SURPL'EMENTAL,.CQNSTR,UCTIO:N USN
DESIGNER/ENGINEER: Not Appli
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name-
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
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.
I certify that no work or installation has commenced priorto the issuance of a permit.
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 1 lictwiith 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 ail 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
withllender or an attorne before commence work or recordin our Notice of Commencement.
Signature of
Agent for Owner
STATE OF FLORIDA 5
COUNTY OF v
Sworn to (or affirm d) and subscribed before me of Physical Presence or Online Notarization
this _U day of Zp_.q by
of person
Personally Known y OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of
ab1l State of Ftj3&I)
� � Suzette R+tch'+e
MV Commission GO 135736
Expttes i2Ji212021
REVIEWS 1 FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR
I REVIEW PLANS I VEGETATION
$ REVIEW LE MANGROVE