HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
V Date: 16 A I 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: W I ff
PROPOSED IMPROVEMENT LOCATION:II ��
Address:
Property Tax ID #:
Site Plan Name: I
Project Name:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors _ Pond
_ Electric %Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Cost of Construction: $ J 1aI-7
. DO
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name mf�!I
Name:
infl
Address:14 5
Compai
iA'L
City: VAIADl State:
Zip Code: �i�l q Fax:
Phone No. 01, 174, U33
Address: *3473 01J Ellrop?
City: Q-sL- State:_
Zip Code: N 5) Fax:
Phone No 77011911
E-Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail M W I
State or County License F
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 confect 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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORJpA
COUNTY OF ! , c
Sworn to11,,(�or affirmed) andsubscribed before me of � Physical Presence or _ Online Notarization
this '�day of -"'�'AA\i 20 ZI by
Name of persorl making statement.
Personally Known �< OR Produced Identification
Type Produced
peff��Identification
�&' naL�et. Ylio''6 & "-
(Signature of Notary Public- State of Florida )
Commission No, (aG 310'775 (Seal):
iA BRENDA R. DECARA
�i-t Notary Public •State of Florida
Commission M GG 310775
.orN
My Comm. Expires Jul 1, 2023
Bonded through National Notary Assn.
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