HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r� (11 I 2t Permit Number:
,�:-n LUgM9
° Building Permit Application
Planning and Development Services
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: �. rcoSr
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax lD #: oO�rI"_ Opt$ Poo , % Lot No.
Site Plan Name: ykp t-oC.�� r�SldCiYlCy Block No.
Project Name:YJfV bli PSIG��L
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1400 Sq. Ft. of First Floor:
Cost of Construction: $ I7-S00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJ
Address: O W
Name: J _ ( {
Company:
City: vuirv-� (;;� State: CIL,
Zip Code:3440 U Fax:
Phone No. to 10 � 0100( - 2A30
Address:`jly'10 < (sty
City:5a� Stater
Zip Code:'34,q°L'7 Fax:
Phone No'0-1� 2$�!2 1—S
E-Mail: 0(AtVv I'7—& kvv'1Ci..t1:.
Fill in fee simp�Holder�n next page (if different
from the Owner listed above)
(`
E-Mail 6bc,602V 1 I LCNv I
State or County License CU- I
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Ap icable
MORTGAGE COMPANY: —No App icable
Name:
Name:
Address:
Address:
City: Z State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE H ER: _ 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 that
or and covenants 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 Ownzf/Y&aOtontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn4 (or affir ed) and subscribed before me of _ Physical Presence or _ Online Notarization
this FLn�dayof�t�1 20�1 by
Name of person making s atement.
Personally Known lOR d ed Id ification
Pro
Type of Identification Produced
THOMAS M STEVENS
(Signature of Notary Public -State o Flor a) ". nmmission
7. Expires Odobv,0,2023
- n,d„nn�1,yr.,i„:�,nnn_aoe.mra
Commission No. (Seal'"
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev