HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ii
Date: I Permit Number:
91FO [LUC E-
O f7 ri�
°rM ° 1 Iftilding 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 CBDG Funding
Address:
Property Tax ID #: 29t)— ccoz— `-1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
k
New Electrical Meter Second Electrical Meter,
CONSTRUCTION INFORMATION:?
(Affidavit required)
Additional work to be performed under this permit— check all that apply:
_Mechanical as Tank Gas Piping _ Shutters _
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: ! Sq. Ft. of First Floor:
_ Windows/Doors Pond
Roof Pitch
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: :z
CONTRACTOR:
Name I
Name:
Address: A
Compan
.
City: EKAISLI oc I State: fJ
Ad s•
Zip Code: Fax:
City:
State: YL
Phone No. E-
Zip Code:
Fax.
Mail:
Phone No
��-
Fill in fee simple Title Holder on next page (if different
E-Mai F1b✓�'
from the Owner listed above) i
i
State or County License
If value of construction is 2500 or more, a RECORDED Notice of commencement is requires.
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:
I
Address:
City:
City: State:
Zip: Phone
__JState:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
1
Name:
Address:
Address:
City:
I
City:
Zip: Phone:
1
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 thatlis granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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, rwalls, 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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agf ent for Owner
STATE OF FLORI A
COUNTY OF
Swm,,n',t11 (or affir ed) and subscribed before me of Physical Presence or Online Notarization
thi��-I� day of LQaA,,SA 20 Eby
iAa mw
Name of person making statement.
Personally Known `� OR Produced Identification
Ty p of Identification Produc
L
l
(Signature of Notary Pu c- State of Florida)]
KRISTEN M,1RIE FOLLANO
�
Commission No. � �5 Seal) �;� yctp ry Public - State of Florida
0 9
t Commission d is!- 64933
EF 1. My Comm. Expires Nov 18, 2024
:cf'ce::rrcLgr %ar'cna Votary Assn.
I
REVIEWS
FRONT
I
ZONING i
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW I
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
'
COMPLETED
1
Rev 5/ZU/Z1