HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEJXFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: EIVED Permit Number: V
REC
0
uc county
Shftg 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:
Address: Ala Ael �
Property Tax ID#: - C2 5 00— N&I-000 Lot No.
Site Plan Name: Block No.
Project Name: /40D P
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$ 3 7i 4L .`A ", "7#3 ' �; a �rn:.
RIP Io� +� h
, '� ..,s_.�..R-.sM . - �y Yes
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additi al work to be performed under this permit-check all that apply:
— —
rMechanical 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: $ /, 2L�` Utilities: Sewer Septic Building Height:
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Name q�f' a//o Name: glow: ro yr ec
Address: Company:
City: _State:�` Address: 09V 6 7
Zip Code: Fax: City: f e,,-e State:I-c-1
Phone No. 772— V'i I - 077Z Zip Code: 329 Vif Fax:
E-Mail: Phone No cF�
Fill in fee simple Title Holder on next page ( if different E-Mail 2/ v���e� ��.4 L'c
from the Owner listed above) State or County License J9 3S.
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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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 a rn efore commencing work or recording our Notice of Commencement.
Signature of Owner/Les ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affied)a subscribed before me of Physical Presence or Online Notarization
this�day of 20�1 by
7'M V
Name of person making statement.
Personally Known OR Pro ed Id V i ati
Type of Identification Produced-
?
d J L.
Vv
(Signature of Notary Public-State of A ri
Commis
....,, ELLEN VAUG N
State of Florida-Notary Public
_+ *_ commission # GG 270079
My Commission Expires
REVIE '� O NT ZONING' SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev S 2