HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,2-2- k Permit Number:
g-'V" ul,
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Building Permit Application
tanning and Development S vices
uilding and Code RegulationDivision Commercial Residential
300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fa : (772)462-1578
ERMIT APPLICATiO FOR:
ROPOSED IMPROVEMENT LOCATION:
A dress: (nsa Q!L4' mr--
P operty Tax 1D#: — Lot No. `,^_�
Site Plan Name: Block No.
P oject Name:
ETAiLEO DESCRIPTION OF WORK:
AD
New Electrical Meter Second Electrical Meter (Affidavit required)
LCONSTROCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
Mechanical _ as Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric ZI mbing _Sprinklers _Generator Roof Pitch
T tat q. Ft of Construction Sq. Ft.of First Floor-
Cast c f Construction:$ Utilities: —Sewer _Septic Building Height:
O NER/ ES SEE: CONTRACTOR:
Na rT a Name:
Add s: Company:
CityIod 49s, I State: IFL Addre!s�s: .5,2b 6(W
Zip ode: 31�� _ Fax: City: lr� �& "e, State:Fe
Pha a Na. Zip Code: 9&(a Fax:
E-Mail: Phone No 'Jr — logn
Fill in fee simple Title Holder on next page(if different E-Mail 1,001
fro the Owner listed above) State or County License
R Val a of construction is 250 or more,a RECORDED Notice of Commencement is required.
d.Val a of HAVC is$7,500 or ore,a RECORDED Notice of Commencement is required.
U PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
i
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
,Name: Name:
Address: Address:
;City State: City: State:
Zip: Phone Zip: Phone:
1 EE',SIMPLE TITLE HOLD R: Not Applicable BONDING COMPANY: —Not Applicable
Name:_ _ Name:
Add
lIress- Address:
CityE City:
ip: Phon Zip: Phone:
OWNER/CONTRACTOR FFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I i ertify that no work or install tion 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
vr'hich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with our Home Owners Association and review your deed for any restrictions which may apply.
III consideration of the grantin 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,swimmi g pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Y 3ur failure to Record a Notice of Commencement may result in paying twice for
improvements to YOL r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and pos ed 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.
Pgrifure of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA '
COUNTY OF L ucA if—
Sworn to(or affirmed)and s bscribed before me of Physical Presence or Online Notarization
(this I2—dayof 20 S by
i
i
;Name of person making statement.
Personally Known R Produced Identification
Type of Identification Produced
t
ig ature of Notary Public-State of FlotiUa)
KRISTEN L BENSLEV
Commission No. 6-6-g l# (Seal) wry Public•State of Florida
Commission#GG 964164
d '
iAy Comm.Expires Mar ti),2624
m.Banded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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