HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��i/
Date: Permit Number: � / 0 -7 — O 6 p ,�
91r. LONE REGEI�ED
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' ° Building Permit Application 91011
Planning and Development Services per 'ttin9 Coun yens
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: �� �tdo�J S �►'�.'n ��asS'No �.Q [acevne
PROPOSED IMPROVEMENT -LOCATION
Address: , 6
Property Tax ID #:� _ �`� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED pESCRIPTION OF WORK:
l) fed •(✓
New Electrical Meter Second Electrical Meter
(.CONSTRUCTION I4N (O.M. iON..
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: $ : J (®� Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE ..
CONTRACTOR:`
Name
Name: �e 1�'9.� G3/-tlt0_
Address• 7/q 66600,,(;5
Company
City: State:
Address: l
Zip Code: 77_3 Fax:
City: C-s�r,'JJA State: L
Phone No.
Zip Code:Fax:
E-Mail:
Phone No i" Q/'����d
Fill in fee simple Title Holder on next page ( if different
E-Mail /6"C �f�� C��dG• C�OiYJ
from the Owner listed above)
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: _ NotrApp
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
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 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 Ianrlar nr an nttnrnPV hPfnrP rnmmanring work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 12020 by
this day of 12020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Prod e41��
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida Hannah Do Ruyss
NOTARY PUBLIC
Commission No. (Seal)
Commission No. S _9TATE OF FLORID
. Comm# GG241993
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Rev. 5/b/ZU