HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number: 2 lo'S - U3�5- /
`�C L s
c`L Lz Building Permit Application Rrcfww
Planning and Development Services 101�
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 oermiE`n9 0 C1aunW
Phone: (772) 462-1553 Fax: (772) 462-1578 5t. I Ilei
2
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5_10 / 8 Ab L &og)T—L2r .
Property Tax ID #: 17y(Z - ISO$-OZ/Z- 000- 0 Lot No.- .17_
Site Plan Name: Block No. 116—
Project Name:'
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $
Gas Piping
Sprinklers
(Affidavit required)
_ Shutters V Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
v 4_0 1 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name
Address:
City: Cr A! GQc--e State: 411:2
Zip Code: 3k !7g'Z __- Fax:
Phone No. , dl--.4 p1-3
E-Mail: ,j/-?e///V,IY A) Z)v-e • CO I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
/,
Address: 15-0/f fd,c kwy l 0e.
City: QCe. Stater
Zip Code:,� ��2 Fax:
Phone No 7 7 2 - Va % 40/3
E-Mail k:.P(T
1 v, l & Z&✓-C CU.!/1.
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
j
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 attorr)ey before commencing work or recording our Notice of Commencement.
Sig re of Ow r Lessee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY C
Sworn to (or affirmed) and subscribed before me of 'Physical Presence or Online Notarization
this day of 2071 by
Name of person making statement.
Personally Known OR Produced dentification
Type of Identification Produced
Agnature
( of Notary Publi State of Florida) HEATHER BURFORD
� 1�Y PUBS
Commission No. Seal State of Florida -Notary Public
(Seal) Commission # GG 183217
;'�_
�o.��d° My Commission Expires
1011 !" February 06, 2022
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ev 5/20/21