HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
(-b- - f
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Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT L CATION:
Address: n Wollw
Property Tax ID #: L V "00L "'
Site Plan Nam
Project Namet / �IR _/
DETAILED DESCRIPTION OF WORK:
Residential X
Lot No.
Block No.
New Electrical Meter ,Second Electrical Meter , (Affidavit remirPril
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Iechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
'14 Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 It �0 .� Utilities: —Sewer —Septic Building Height:
LOWNER/LESSEE:
CONTRA
Name A
Name:
Address:
Company:
City:�4" ?(�ir Stater
61r'
Addr
Zip Code: 34gB 1 Fax:
City:
Phone No. �� � —�
Zip Code:
E-Mail:
Phone No J
Fill in fee simpYe Title Holder on next page ( if different
E-Mail_
from the Owner listed above)
State or Coun
11
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.
Fax:
,In
•NAVY
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: _ _ _ T State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
_ 7
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
L-
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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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
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 commencine work or recording vour Notice of Commencement.
�& �k ��Xus'o' �'i -
Sigtiatsre of Ownerl Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF J)yuGhybeL
Sworn to (or affir ed) and bscribed before me of Physical Presence or Online Notarization
this � day of 20_ by
Name of person making statement.
Personally Known OR Prod ced Identification N
T e Identification Produced �r
(Signature of o "P4P-
MARY BRtOWf N
Notary ooFl
oridaCommission No. -3
<c ommis ion HH 37071
;;FOFF1dF;•' My Commission Expires
Au ust 26, 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED J