HomeMy WebLinkAboutBUILDING PERMIT APPLICATION11 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91ro
0
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: )Ze,
PROPOSED IMPROVEMENT LOCATION:
Address: R-`� C
Property Tax ID #: CD--c� — Lot No. 0Site Plan Name: `� �(� Block No. L-()
Project Name:
DETAILED DESCRIPTION OF WORK:
S al r fik.a
New Electrical Meter Second Electrical Meter
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 I
— Electric _ Plumbing — Sprinklers
Generator
— �
_
Roof s ' � a pitch
Total Sq. Ft of Construction: a \ Ob Sq.
_ .
rr,,
Cost of Construction: CA Sod
Ft. of First Floor:
$ I Utilities:
—Sewer —Septic
Building Height: 1
OWNER/LESSEE:
CONTRACTOR:
Name �1
Address: IOC. S
Name:
City:r
O �� State:, L
Company: (�
S \
Zip Code: 1 Fax: N I a
Address:
City:
Phone No.
State:
E-Mail:
Zip Code:
Phone No
_
� \
FS ` 1 V
Fill in fee simple Title Holder on next page ( if different
E-Mail S
b
from the Owner listed above)
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State r County License—�_J�
1
1 ID l
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.
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: V 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 attornev before commencing work or recording your Notice of Commencement.
Signatu ne ee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF inc`QA`�
Sworn to r affirm )and sus Ibed bef me of Physical Presence or Online Notarization
this U day of 201t by
6ul(ba a
Name of person malLng statement.
Personally Known OR Produced Identification
TyAof Identification Produced
(Signature of Nott/ y ubli/c--�State of Florida )
Commission No. l� V I (Seyhh'"°°�•. ��IM.VIEYRA
��V; 2:.•..,' MY COMMISSION#GG907977
*_
EXPIRES: August27,2023 •,
Bonded Thru wtary Public Underntfiters
Of F�..•
REVIEWS FRONT I ZONING
COUNTER l REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISOR PLANS I VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW