HomeMy WebLinkAboutBuilding_Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '� Permit Number:
O
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: E, ec
PROPOSED IMPROVEMENT LOCATION:
Address: I ��r a t�.Cl'�l XN&� P_ `�-A _ :V I �,O q9i
Property Tax ID #:
Site Plan Name:
Project Name:
IBC-�Y1�
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
we
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 _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: >
Cost of Construction: $ 1. 9 o
Sq. Ft. of First Floor:
Utilities: `Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name-' NIA ctCen+ '` vc .
Address: I ` 1%, N o -rx u1 t b_ AJ e
City: State:
Zip Code: Fax:
Phone No.
Name: +, `1
Company: ., - C
Address: ? Ys- J-,J G i er)-h2� A \J e-
City:
Zip Code: ��� (�' .�
Phone No��'TD qbY
E-Mail � p¢ } by �c
State: F(-
Fax:
L4I I
r5 nt c,����) . -0 A\,
E-Mail: —
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
State or County License
d ;17 4 i Q
IT value oT construction is Z5UU 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.
-
,. � .
DESIGNER/ENGINEER: NotApplicableMORTGAGE
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 a efore cmaiencing work or recording our Notice of Commencement.
Sig ure w er esseej ont cto ent or Own
STATE OF FLORIDA
COUNTY OF r 1 (''
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
thii(s t day of i n 20.11 by
,
`� J �1.hfl I (,1r°�t(-�--�-( Pi SAVANNAS71LLWlri�t
Name of person making statement.
a- EXPIRES: March 19, 2022
Bonded rnti rotary Publk u�rtx�r
Personally Known X OR Produced identification
Type of Identification Produced _
r t;
(signature of Notary Public- State of Florida J ZZOV61, 40iffl:S311IdX3 €; t;
Commission No. I (Seat) $99161. 'D..J� #�1eN,[O�IIS�SIVIRODAR Ilk. A
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DATE
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