HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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:
DETAILED DESCRIPTION OF WORK:
f M9 C U411 T --'H t l V - I -A 1-t1rV
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
'Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator
Sq. Ft, of First Floor:
Lot No.
Block No.
Windows/Doors _ Pond
_ Roof Pitch
Utilities: Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �caoc ' 'u I�l('t.S
— -_ j _
Name: paj
Company:
Address: RoIO Rort'_ilct' Q4.
City: Pry(+ ( -aC ( f State: EL
Zip Code: �3L1C3,12 Fax:
Phone No.--))I-3�A �� )
Address: tin e-C 4 ft-t' -
City: J�— State:�L
Zip Code: 3`� Fax: t":�
��,�
Phone No '-)'1 Z — 29P
E-mail: K(Ay COI @ b[ QI I • (&n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0_001. L
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.
SUPPLEMENT AL,CONSTRUCTIQN LIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
_
Address:
City: State:
City:
Zip: Phone
_State:
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
ovements to your property. A Notice of Commencement must be recorded in the public records of St.
4im
L i County nd posted on the 'obsite before the first inspection. If you intend to obtain financing, consult
i le er Van att ney Okfqfe commencingcommeng:ing work or recording our Notice of Commencement.
Si atu of 0 er/ essee/Contracor tas Agent for Owner
STATE OF FLORIDA
COUNTY OF � n!
Sworn to (or affir ed) ands bscribed before me of +� Physical Presence or Online Notarization
this !_ day of iC� 207A by
y V Otkecd
_�
ement. l
Name o person aki7011
Personally Known Produced Identification
Type of identification Produced
1
l
C✓1vC
(Signat re of Not ry Public- St to of Flo ida )
Commission No 10 (Seal)MntMraMnRcwIS
MY COMMISSION # W 040779
.;
EXPIRES: November 12, 2024
•'jFOi iW W..W Ttw Notary Pubk Undwwrilera
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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