HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: " / / i q / C�31
Permit Number:
�)`Io LULL CME
o �
P 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:
Address: _�}C
PropertyTaxlD#: �MOq-`7,D\1 00V `DC)C}-LI Lot No A �';D
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical
Electric
_Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_
_Sprinklers
_Shutters
(Affidavit required)
Windows/Doors
Block N
a.
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Building Height:
`
Name Q �;. f` Cjc)r Af + Name: e t l �t k C7
Address: i 0("T) l�'}F C C I( (�y Company: a � � .
City: Ford- Pie ccState: ice- L- Address: k 3`� e. rx t cC , r`. � I Vd
Zip Code: � Lj9 b0� Fax: City: S&asA-i Ct r\ State:
Phone No. 'Ilc� — 'La 61Ui� Zip Code: � 2--gS9 Fax: `i ld - 3cn -olq j
E-Mail: Phone NoTjo �J
Fill in fee simple Title Holder on next page ( if different E-Mail�OrKkn acne
from the Owner listed above) State or County License i7.0 (X)C) (Ci ( 1
If value
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
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 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.
Luci nt and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi nder or an attorney before commencing work or recording our Notice of Commencement.
S' at of Owner/Sessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF kndjcC1 iZ;'SIP.(
Sworn to (or affirmed) and subscribed before me of hysical Presence or Online Notarization
this A. d_ay� �A_I I k N1 20c2l by
pof
Name of person making statement,
,Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Sig ture of Notary Public- State of Florida)
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Commission No. {{€ 4A my", NOWy PUONc Sraa of FbAtla
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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