HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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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 CBDG Funding
PERMIT APPLICATION FOR: - �..)��,�
PROPOSED IMPROVEMENT LOCATION:
Address: �Je 0 1 VDO,1 ,,y -, L
Property Tax ID #: Lot No.'2�19
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: $ 1 ,Z20 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name : IN k
Name:
Address: 151Q
Company:-
City:f(`.,r- - Pi C (::Q- State:T-L.
Zip Code:I G 1 Fax: 01 (j j
Phone No. ) 1L4 - ` C--J __ -7 (ro -7 E-
Address: I -I2) i -xrc,,;,�_
City: S- �C'
Zip Code: :199S
Phone No .�1� -- �jGi�j_
Fax: --- T)p
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State: 'FZ
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Mail: )- & $'UCLe f'Oyu, , [ py)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County License C)
it value of construction is Z5UU 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:
City:
City:
Zip: Phone:
Zip: Phone:
UWNtK/ CONTKACTOK 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 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, 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 attornev before commencing work or recording vour Notice of CnmmPnrPmnnt
Signature of er essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
this C;'X''1 day of'! 2041 by
���V 1 �4 C.J ! > 1 9 1 Lti. Y lyC..1`14.-.K.✓
Name of person making statement.
Personally Known J OR Produced Identification
Type of Identification Produced
(Signature of 6btary Public- State of Flori,.�dy.,�,.��,
r� a1�° �� Notary Public State of Florida
Commission No. 1 (Seal) �i Cheryl Fowles
yr My Commission HH 116177
era Expires 04/11/2025
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