HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S`yra WCIE
Building permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 �^
Phone:(772)452-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address: S� (`Q (.A15- 4 .
Property Tax ID#: OV — Lot No.__a__ �
Site Plan Name: U - V6 Block No.
Project Name:
CIS
New.Electrical Meter Second Electrical-Meter
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,. nn _ Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
Name Name:
Address:3abLA
r ' ' Company:
City: -��.�� -State: Address:_M9A n Lk-)Q S�
Fax: City: t
Zip Code-3LC �]lJ�u 1� � Stater
Phone No Qn-5t8---BLY Zip Code: �S— Fax:
E-Mail. Phone No `
Fill in fee simple Title Holder on next page(if different E-Mail , 2Q bff-4 NO—_ 'r'- OQ1lf
from the Owner listed above) State or County License Q _Y-S—
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.
DESIGNER/ENGINEER: Not Applicable K 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 priorto 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 Assoc€ation 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 OW4ailureto Record a Notice of Commencement may result in paying twice for
improvementsoperty. A Notice of Commencement must be rec ded in the public records of St.
Lucie County an the jobsite before the first inspection. If yo tend to obtain financing, consult
with lender before commencin work or record' otice of Commencement.
Signature of i r ntractor as Agent for Owner Sign
at of Con r/License Holder
STATE OF FLOR D STATE OF FLORi .
COUNTY OF COUNTY OF
S to(or affirmed)and subscribed before me of S or o(or affirmed) and subscribed before me of
sical Presence qr Online Notarization Ph sisal Presence or Online Notarization
this day of L{( Eby 1111s day of 2=b
ace i ~C
Name of person making statement. Name of person making statement.
Perso y K n Produced Identification rsonally lC e�nt roduced Identification
�of ��� € €cationrA
Pro Prod d
(Si azure o ry Pu c-State �0 �}0�9 ig ture otary lic-State of Florid
Cs �r
Commission No. � Commission No. eal)
Ilee0oG�� N� F RpSE�� 4_`� A�9
REVIEWS 1. pore; ING SUPERVISOR PLANS E fil(9 MANGROVE
NCO REVIEW REVIEW REVIEW i ' REVIEW
DATE
RECEIVED
DATE
COMPLEI D
Rev. 0