HomeMy WebLinkAboutBUILDING PERMIT APPLICATRIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -Oupala l Permit Number:
T
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fly 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:
PROPOSED IMPROVEMENT LOCATION:
Address
Property Tax ID #: �Ci10 " 030 ' lJw Lot No.
Site Plan Name: Block No.
Project Name: S-�h\ V �'\ 0 Q
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
(Affidavit required)
Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 16H1
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ?)) CG > S�oFC P 1
Name:
Address: �_Cw0(`AM#-At ( } A
� '
Company: ug&f
City: LA Cdfmni State:
Zip Code: h IS_1 Fax:
Phone No. SiIO" 510 " CLAN
Address: 20 ?SOX 'MS
City:?() �� LUC _ Stater
Zip Code: Fax:
Phone No
E-Mail • G C.- I
E-Mail:�k lrnrr�'� co'(`'--\
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORUEU Notice oT commencement is requucu.
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.
Lucie County and posted on the?jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
i`
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF F- LI lZie
Physical Presence or
Sworn to (or affirmed) and subscribed before me of
this � day of , 20021 by
k pr� 9�ng�c
Name of person making statement.
Personally Known V OR Produced Identification
Type of Idtification Produc27
(Signature of Notary Public- State of Florida )
Commission No.CQ1 �� (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
t���► ALISON HANSON
"'A
�;. MY COMMISSION JOG
970043
'••,"; p� EXPIRES: March 16, 2024
Bonded Thru Notary Public Underwriters
Online Notarization
SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
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