HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number: _
- � LLCCIIL
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 CBDG Funding
PERMIT APPLICATION FOR: kyocT
PROPOSED IMPROVEMENT LOCATION,:
Address: I I 1\-)I I \j" pp
Property Tax ID #:4-)Lot No. !J
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
no VON'D
New Electrical eter Second Electrical Meter (Affidavit required)
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 01 12 Z I�—Pitch
Total Sq. Ft of Construction: " Sq. Ft. of First Floor: 60
Cost of Construction: $ 0z 1 000. 00 Utilities: —Sewer _Septic Building Height: 2c'
OWNER/LESSEE:
CONTRACTOR:
Name
Addres
n
Name:
.
VX
Del
Company:
City: �p V I l 1 State:
Zip Code: Fax:
Phone No. E-
Address:
City: I Ga State:
Zip Code: Fax:
Phone No 71��-, )
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License° f 5 � 0
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ANot Applicable
Name:
Address:
BONDING COMPANY: t Applicable
Name:
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 conflicts with au applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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 recordings vour Notice of Commencement.
Signat re of Owner/ Lessee/ ntractor as Agent for Owner
STATE OF FLORIDA ��
COUNTY OF
I �
Sworn (or affirmed) subscribed
be;fQrte me of hysical Presence or Online Notarization
this day of
20 by
fifi
Name of person making statement. -
Personally Known OR Produced Identification
Type of I en 'fi 'on P oduced
Signa ota lic- State of Florida)
Commission No.
(Seal) f^'=
°a4'RrKATHERINE HAVENS
MY CDMMISSgDN #6i:165030
F ` EXPIRES: DEC 04, 2021
µ° » Bonded through 1st State insurance
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