HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 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
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PERMIT APPLICATION FOR; �i���j��. P��G ���� OleC�/%!Q
PROPOSED IMPROVEMENT LOCATION: ,--�
Address: f}/7e DrPZ`'
Property Tax ID 4: CwO6 O QO Lot No. 5v
Site Plan Name: 2 L, $f Block No.
Project Name: ,� �S' C
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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
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Total Sq. Ft of Construction: ,-21 Sq. Ft. of First Floor:
Cost of Construction: $ =M za Utilities: —Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name P/iS fi L `5
ffi�
Name:
Address:
Company:�i�EX z2f1!144eX
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City:
Zip Code: v�Fax:
Phone No. / Gzi —115e
State:
Address:
City: 7
Zip Code: �
hone No
5ta
Fax:
E-Mail:
Fill in fee simple Title Holder on next page
from the Owner listed above)
(if different
E-Mail ��
eX r/C'/'S•
State or County License
Jt'
n vawe or consrrucrion is Lsuu or more, a KrLUKUtU Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/ ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF /fjf
Sw r (or affirmed) and subscribed before me of
Sworn or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this�dayof 2021 by
Physical Presence Online No arization
this day of 207 by
Name of person making statement.
Name of person making statement.
`
Personally Known OR Produced Identificationy
Personally Known L/OR Produced Identification
Type of Identifi ation //
Produced �L A�Z_ jb ' L�v 3�
Type of Identification
Produced
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(Signature of N1,6tary Public-
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i N ,.ary Public :,;a.s of No
Commission No. FJ (�a�"�'� _Il �y
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ev. 5/6/20