HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 Z 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:
-PR _OPOSED•IMPROVEMENT LOCATION:-,
Address: (61 0!
Property Tax ID #: �
Site Plan Name:
Project Name:
Lot No.
Block No.
D
DESCRIPTION,,,,0 F WORK,",,';,-,i
. -/-,rxA 1A a-0-z 4
New Electrical Meter
Second Electrical Meter
ATION:
"tdNST-'kUCt,I'N,'I'NFOR"'M"'
(Affidavit required)
Additional work to be performed under this permit - check all that apply:
i
4-/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: $ 41 QQ(9 Utilities: -Sewer -Septic Bdilding Height:
I
,OWNER/LESSEE -
CONTRACT OR
Name RV i I 11M d 14 14
Name:
Address: 0102, SCOAA-alhop (M/
City: P) -,e Lic-e State:
Zip Code: 2 7z- �, Fax:
Phone No. 77 Z S-7 -0 2�2 2- E-
Company:
Address: 575� 2- z U A3
City: 1 1'104 4 , OU &',_L '�tate:
Zip Code: Z F K_ t"-� Fax:
Phone No -77?- 7 P-a 2-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ef c? Pi acts
0 ko o -
State or County License A r_/ 'tl
?0
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.
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5UPPIEMEN Al"XONSTRUCTION't
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N L " IN >�RI�/IATIa.N _ i
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DESIGNER/ENGI Not Applicable
MORTGAGE CO/{�NY: _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:
I
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 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
witblender or an attorney before commencing; work or recording your Notice ofiCommencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S `�
Sworn to (or affirmed) and subscribed before me of p Physical Presence or Online Notarization
this 6 (Clay of C , , 20A by
if
Name of person making statement.
Personally Known OR Produced Identification/
Type of Identification Produced
(S'
C
`Syp/� ELLEN VAUGHN
"'s -o Mate of Florida-Notary��J�� is
°* •_ Commission /007�
OF F,O� My Commission Expires
October 22, 2022
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