HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /I�
37
Date: �� � Permit Numbltl Ete !> V
Qepartent
.-.O. r rn
R _-w o; , . __. PB;►r1tt1 ucle County
.Building Permit Appflcatibff
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:
Address: t' b'i -t reQE-:;+:
Property Tax ID #: 3 C51 _73 =oco Lot No. l 6
Site Plan Name: i �/E 1"' �0.y"` U �h� Block No. �Sa
Project Name: 7FQ yl C• 'e
ill
INV
New Electrical Meter Second Electrical Meter (Affidavit requireal
Additional work to be performed under this permit — check all that apply: X
_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:
JQ t ,.
Cost of Construction: $ Od Utilities: _ Sewer _ Septic Building Height:
f - •'S ., +F:�3'-t � dye
'44i�£J 9 r�s 'E3-•ta
� wal 4;
_
�ft
Name A,i a _ e-
Name:
Address: l -,M rE I Y)
Company:
City: State:-Z._.
Zip Code: 4RZ k,Fax:
�
Phone No. `j
'Address:
City: State:
Zip Code: Fax:
hone No
E-Mail: �0A -C-o
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
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.
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 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 & 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
rt A Notice of Commencement must be recorded in the public records of St.
improvements to.your prJehey�obsjte
Lucie County and posted before the first inspection. If you intend to obtain financing, consult
with lender or n a orefore commencing, work or recording our Notice of Commencement.
Signature of Owne /-Les a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SLycz,
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 0-3 day of 20:7,4 by
Name of person making statement.
1
Personally Known OR Produce Identification
-Produced
Type of Identification
(Signature of Notary Public- Staa of Florida )
HEATHER BURFORD
Commission No. (Seal) ,.��Yp��,,
S` State of Florida -Notary Public
_+ *= Commission # GG 183217
y9� oQ° My Commission Expires
February 06, 2022
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