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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
Residential 11�
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Address: ( b she etA PS Li Ft- ✓ qfj dZ :
Property Tax ID#: 3q 1 �- 705- 060 7 - 060- 6 Lot No.y/
Site Plan Name: 56a Block No.
Project Name: _,�d ) Q
New Electrical Meter Second Electrical Meter (Affidavit required)
ItONSTRUCTION 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: $ o?
yab.
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer -, Septic Building Height:
Name v 4 v If Yi
Address: 6A
City:
j L StaterL
Zip Code:.3L49' ?- Fax: '1 a
Phone No.
E-Mail:
Fill in fee simIlle Title Holder on next page (if different
from the Owner listed above)
1'COWRACTUK: ,1
Name:
b1 All
Company:
Address:- S LTl d p--
City: T ` j��/ Stater
Zip Code: �7 9 03 Fax: h a
Phone No 3-); , - 7
E-Mail dtcav►ida?�GVICeilfc
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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.
SUPPLEMEN CFEO' NSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: Applicable
Name:
_mot
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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner see ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 5-7—. v1=4(F
Sworn to jor affirms ) Tnd subscribed before me of _ Physical Presence or Online Notarization
thisr 64 ay of Jy tA , 2021 by
Name of perso making statement.
Personally Known OR Produced Identification
Type dentification Produced
(Sign atur ary Public- State of Florida )
1 You¢; JAIMEORTIZ
�yUl Notary Cubllc - State of Florida
Commission No. (Sea Commission # GG 22J444
`'Fora' My Comm, Expires Jun 13, 2022
Bonded through National Notary Afsn,
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Rev S 20721