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 Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Residential X%
Address: �JIOt% IA9CaSt�Ey D12 FdR j j'IF2cF, F� 3 c/9y6
Property Tax lD #: I Nag' go,7- onoc6 " 000O S Lot No. oz 6 g
Site Plan Name: W I LL6 E444C:1>tl MS Block No.
Project Name: W I L_L J E 1.( q (,n L� I k) S
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical
_
Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ I b
_Gas Piping
_Sprinklers
(Affidavit required)
_Shutters
_Windows/Doors _Pond
_Generator Roof Pitch
Sq. Ft. of First Floor: /
Utilities: _Sewer _Septic Building Height:
OWN�R�LE$SEE-
P
Name �% i ��1? I
G
C, ✓�i
Name:_
a_
Address:131 o7 K(oc-tSLEV
RJR
Company I E
City: FGIZT PIE 2CE
State:
Add r ss: 1'1 1
rn'
V %
City: 1
State: �L
Zip Code: 4 tit Fax:
Phone No.(Cf 0y) 34 q-Sob
6
Zip Code: 3?)t-A� l f)
Phone No 5zy --32i
Fax: t.01t) I
(7 '.7(�
E-Mail: (cE7r-M (1j1hQl+MA'L CDM
•
Fill in fee simple Title Holder on
next page ( if different
E-Mail Vll(.iI
V-V(D i i
I '(,C41
State or County License
C -cc D �Pa 7
from the Owner listed above)
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.
St�PPLEM) �1fiALONSTRUCTIQN LIEN LAW INFQ'RMAfION
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 permitto 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 Count yy 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 attoWey before commencing work or recording your Notice of Commencement.
Signature or uwner/ LessedfLontractm as Hgem iui owner
STATE OF FLORIDA
COUNTY OF _�j�G--
Swor to (or affir ed) and subscribed before me of
this day of 20� by
Name of person mak
Personally Known
Type of Id 'ficatior
(Signature of Notary
Commission No,
REVIEWS
RECEIVED
OR Produced Identification
of
Physica
l Presence or Online Notarization
CAITLINFIE,iI-
Seal
( l MY COMMISSION Yf Nl-I Of `SJ5
EXPIRES! November 1 �k
1.02
.`� Bonded Thfu No'aq Publ' U�idor.!�rilc
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REVIEWOR
REVIEW
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