HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: __M� 2..�. I Permit Number:
9V. CUL -
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:MWIV
PROPOSrrE,^�D IMPROVEMENT LOCATION:
W Address: PLOI Wood
Property Tax ID #: 1 `' L1U Lot No.51— _
Site Plan Name: NA,dylifj A� Block No.
IJ
Project Name: A ma
DETAILED DESCRIPTION OF WOR .
J�Q
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be pe ormed under this permit ,check all that apply:
_Mechanical Gas Tank V/isGas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ {. Utilities: _ Sewer —Septic Building Height:
OWNE /LESSEE: CONTRACTOR:
Name NamAe,
Add a Com
City: lr Stat _ Add Zip Code: F City:Sta
Phonelm_HFT�' Zip Code: tp Fax:
E-Mail: of y PhoneANoFill in fee simple Title older on next page ( if different E-Mail DM •from the Owner listed above) State oAl
If value of construction is 25M or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
SU PP LEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY-- Name: Name:
Address:_ _ _ Address:
City: State: City:
Zip: Phone Zip: Phone:_
_ Not Applicable
State:
FEE SIMPLE TITLEHOLDER: _ 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 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.
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 commencine work or recordine vour Notice of Commencement.
Ae.i,---
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLOi ��-
COUNTY OF VV
Sword to (or affirmed) and subscribed before me of Physical Presence or
this 60 day of AwzuLf 2074- by
t_eG4V*— F, I _Am,
Name of person making statement.
Personally Known _ OR Pr duced Identification
yype of Identification Produced U
(SignaTure of i ry Public -State of Flo aj
"kOyll UB,; MARY BROWN
Commission N7 _ "Notary Public -State of Florida
=s •e Commission # HH 37071
oF�i,�?.' My Commission Expires
August 28, 2024
Online Notarization
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE E
RECEIVED
DATE
r
COMPLETED
rev 57202