HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S `i i �I� LL -,
� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Address: Al 1 I&W Pl •3L4Q5l
Property Tax I ��%111
:� 000 a - 0M ' Lot No,
Site Plan Name: Block No. 39
Project Name:I&'.
New Electrical Meter Second Electrical Meter
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:
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height:
Name 1
Name:
Address:1
City: Stater'
Zip Code: 2�S Fax:
Phone No.cm- gl.
Company:
Addres
AZ
City:
Zip Code:
Phone N
`11
State:
44
Fax: ^ F t2
Z' SS
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail
co MC r- c6m[A
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.
_
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 Counttyy 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 encement must be recorded in the public records of St.
Lucie County and posted on th jobs! ore the first inspection. If you intend to obtain financi g, consult
with lender or an attorney ommencing work or recording your Notice,of Comrr�p�2,pnE}n .
Signature of Owner/
STATE OF FL
COUNTY OF
r as Agent for Owner
SwOn to (or affirmed) and subscribed before me of
Ph sical Pres a or 0 line Notarization
this day of t` 2020 by
Name of person making Bement.
Personally Known oR Produced Identification
Type of Identification
Produced
Signature of Contyaftor/License Holder
STATE OF,16ORI .
COUNTY OF _
r
Svirn to (or affirmed) and subscribed before me of
P sical Pres a or o lone Notarization
t is day of 202�'by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificat on
Produced
-(Signature of Nota P, Sta �aa t to of Fianda
r = t etary u t
99
,Comrr.ission R�eb 9� 2425
Commission N ,-: Comm. E4$tV F
3�rcec chrcugh NE00nal "rotary Ass;"
(Signature of 41�0 ??u�°State WAR6�l96* LOKIE7
oar. tic -State of Florida
r ssior " 73295
Commission No. Comm. Ex res 9, 2425
At,.c-c through wationai notary Assn.
REVIEWS
FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED