HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAN APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Plmning 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: nq lQ
Address: W)C{ `
Property Tax ID #: ZL
Site Plan Name:
Project Name: �(
New Electrical Meter
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Second Electrical
CONSTRUCTION INFORMATION:
(Affidavit requirea)
x
Lot No. —T
Block No.
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: l c)w Sq. Ft. of First Floor: 2� f
Cost of Construction: $ 10�GOD Utilities: Sewer —Septic Building Height: n'
WNER%LE'SS EE:
CONTRACTOR:
Name Cyr \ �
Name:
A. Address:A�A
Company:City:
Address:Zip
City: , ( o� State:_
Zip Code: )�j4(3Fax:
'1 I
Phone No I
State:
Code:L Fax:
Phone No. 0 ' o0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CiAl�
State or County License (P
if value of construction is 2500 or more, a KtCUKUtU IVOLIGe or Wnunenwn�cna •� • cy..•• �...
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
...I,F ENTAL CONSTRUCTION LIEN LAW INFORMA
DESIGNER/ENGINEER• TION
Name: Not Applicable
MORTGAGE COMPANY:
Address:
Name:
City.
Zip: State:
Address:
Phone
City:
FEE SIMPLE TITLE HOLDER:
Zlp. Phone:
Name: Not Applicable
BONDING COMPANY:
Address:
Name:
City:
Address:
Zip: Phone:
City:
Zip: Ph
Applicable
State:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain it 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
structure. Please consult with your Home Owners Association and review our deed for an restrictions which may apply.
y y y tnct or prohibit such
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 our Notice of Commencement.
Signature of �Owne see/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY�\�r
Sworn r affir d a d sa cribed be f me of %` Physical Presence or Online Notarization
this day of 'fit`` 20 c.-Iby
Name of person mikin;rstatement.
Personally Known OR Produced Identification
TypQ.Qf Identificati n Produced
(Signature c(f Jofary ((Public- State of Florida )
Commission No. 1 61 l ]� (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
��' �•: ANALI M. VIEYRA
.. ._ MY COMMISSION # GG 907977
EXPIRES: August27,2023 a %rF. •pP:
Bonded Thru Notary Public Underegiters
SUPERVISOR I PLANS VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW