HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number:
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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 :
P"ROPOSE"D =IMc t PRQ/ VEMNT LOCAT
"fIOfy
Address : 00 tS rA k o A o y1de bi yi V4- I n � 5 1 7
Property Tax lD�#: f( s; 01 ' 101 k Wok - ('; 0c Lot No .
Site Plan Name : r E °t e Ll Block No .
Project Name: 04
DETAILED DESCRIPTION ;OF WgRK
New Electrical Meter Second Electrical Meter (Affidavit required)
CQNST,RUCTION . IN FOR OATIONi
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 : Sq . Ft. of First Floor: r
Cost of Construction : $ } 3 0 Utilities : _ Sewer — Septic Building Height :
OWNER/LESSEE : CONTRACTOR:
Name Name : �
Address LAk& .( C( 61yc( a Company: A
City: r r �c State : f:t Address : I I t y (✓ (�
Zip Code ;. Fax: City: fp Stater_ ,
Phone No . t9 I -90 sa Zip Code : 3 Fax: 8LQG - 3LJ - ° 33
E-Mail : Phone
Fill in fee simple Title Holder on next page ( if different E-Mail Qj P�6 41( tt2VS
from the Owner listed above) State orCounty License Cl e3 Q S3 off.
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.
SUP, PIEMENTAECONSTRUCTION LIEN LAW, INFORMATIONI
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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlictwith 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, 1 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 commencin work or recordin our Notice of Commencement.
ZVI
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFP% �
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 20 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Id tyficatio Produced
(Signatu of Notary Public-`ate of Flo ida )
)i �;,c CAI7LlPd F UL
Commission No. (Seal d MICOMMISSION NI11 U6�595
Y
c��•,�;� EXPIRE& November 19, 2�24
Bonded Thm Notary Public llndervrrilers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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