HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S!"-L " L . ur c. ; u L 74-:, qi%
W41" WIM, 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
PERMIT APPLICATION FOR: C
kri s+ou r_;�4-i an
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
, I ) &'v
`0 S3 (7) Lot No.
1+ T I "'j
, Block No.
New Electrical Meter Second Electrical Meter
(Affidavit required)
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:
Cost of Construction: $ L12 1 4)
Sq. Ft. of First Floor:
Utilities: —Sewer — Septic
Name . t ) � d� f-\ - L(,\K_i f:
Address: -9, L4
_k'" IC —
City: State:
Zip Code: "3LJ n_1 5 1 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name:
Company: C111')k_'�Y4'-V
Address: Q
_21F Cr),rwnN(,2L
City: State:
Zip Code- LA
,�' Fax:
Phone No I Ira Ex", Q — LLB
(I t I
E-Mail
State or County License113 4
IT vaiue OT construction is ZbUU 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
Marne:____.. lame:
Address: Address:
City _ _ State: City: Mate:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
game:
Address: Address:
City:
Zip: Phone: Zip:
OWNER/ CONTRACTOR AFEIDVIT: 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 snakes no representation that is granting a perinit will authorize the permit holder to build the subject structure
which is in eoNict 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,
I In consideration of the granting of this requested permit, I do hereby agree that I wilt, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
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 attorney before commencing work or recording your Notice of Commen cernent.
i.. a
"of
Signature Owner/ Lessee/Contractor; as Agent for Owner
STATE OF FLORIDA
COUNTY +�F,__. � � ��1 �� � � i '��' � it
Sworn to or affirm dl and subscribed before me of Physical Presence or (Online notarization
this ` i" ' ay of _ , 20X by
Name of person making itatement.
Personally Known OR Produced Identification
Type of identification Produced
r'
Signature of Notary Public- Sta f Florida )
Commission No. (Seal)
ELLE P. Z_IMMERMAN
of Florida -Notary Public
mission #1 GG 14163Commission Expires
ptember 09, 2021
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