HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:ZAY f Permit Number:
O
14*,
Building Permit Application
Planning and Development Services
Building and Code Regulction Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR
PROPOSED IMPROVEMENT_ I S_0�
LOCATION: `
Address: I
Property Tax ID#: - 1 ! - - 9 Lot No,
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
04 UCI' Min
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 _Windows/Doors _Pond
—Electric _Plumbing _Sprinklers _Generator V—Roof Pitch
Total Sq. Ft of Construction:�11?114 Sq. Ft. of First Floor: 424/
Cost of Construction:$_3�1JU . Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR: h
Name Name:
Address: Company:
city: State: Address: J�AQ,�- S�.clros,ale. AJaV 110-It 7
Zip Code: Fax: City: uzio k 64-rk State:
Phone No. Zip Cade: 3�Z7e7 Fax:
E-Mail: Phone No
Fill in f simplel-Title Holdek4n next page(if different E-Mail .�
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.
a
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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. Lucre County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult any
hpyour 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
improve is to your property.A Notice of Commencement must be recorded in the public records of St.
Lucie C y and sted on the jobsite before the first inspection.If you intend to obtain financing,consult
with I er or orne before commencingwork or recordingour Notice of Commencement.
ignat re of 0 er/Lessee/Contractor as Agent for Owner Sign o Con ractor/License Haider
STATE OF LORI0Q„ STATE OF FLORIDA
COUNTY OF , `" y ' COUNTY OF 09_A�6
Sworn to(or affirmed)and subscribed before 5w9 to(or affirmed)and subscribed before me of
_Physical Presence or Online Notari tiog m Physical Presence or Online Notarization
e2-3 day of 202Q by 0 this 2(, day of 'TU rJ� 2020 by
c.
N V of person making statement. a o 5 A Name of person making statement.
A ?N7z
nalfy Known OR Produced ldentifi Boa w e Personally Known OR Produced identification
y$ of Identification o a- Type of Identification
ced r Produced
2•- � � �i•vo,4m /I/���
ature of NotaryPublic-State of Florida) (Signature of Notary Public State of Fltridan R.Rupa
tia, al k
moo. y, ;ission No. (Seal) Commission No. I-(H Or7O_S f9Notary Public
�a> — State of Florida
Comm#HH070
Expires 1/2/20 5
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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