HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLILE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
L: i 2I h. I_ ri `
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:
PROPQ ED IMPROVEMENT LOCATION:
Address: I LA i JD L
Property Tax I D #: �' - ��'�Lki J-Y
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
No f4e6-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that a .
_Mechanical _Gas Tank _Gas Piping _ h}'S�tte�s _Windows/Doors
Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ rl iO-1 Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE: CONTRACTOR.
i
Name Name:
G�U`tk
Address: Company: 11 lie
City: State-rAddre
0 Fax: City:
Zip Code: .77,
Stat . R
Phone No�� `` ��0��
. �) ' ��� ' b('9b E Zip Code:
Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail t � 1r
from the Owner listed above) State or County License CV
i.
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.
SUPPLEMENTAL CONSTRU
DESIGNER/ENGINEER:
Name:
Address:
City
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
IfEN LAW'INFORMATION:
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
_Not Applicable
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 an applicable Homeowners Association rules, bylaws or and covenants that may restrIct or prohibit such
structure. Please consult 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 theJo before the first inspect' you intend to obtain financing, consult
with lender or an attarne. commencinn work or r inR vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FL
COUNTY OF
SworIo (or affir d) and sub ribed before me of :�/Physical Presence or Online Notarization
this / day of 20,A by
Name of person making
Personally Known _ JeL"' OR Produced Identification
rVpe Of Identification Produced.
of NotaryPublic-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Wynn Aden
I Comm.6GG3663662
I
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW J REVIEW REVIEW REVIEW REVIEW