HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:ft
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Building Permit Application lZOZ 9 0 Jny
Planning and Development Services CIM303LI
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: I
PFoC _ erty Tax ID #: T Z is oZ — 10— D`J �3^08o /s` Lot No._
Site Plan Name: Block No.
Project Name:
ew Electrical Meter
Second Electrical Meter
iv,J-46t (l vex
(Affidavit required)
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
Total Sq. Ft of Construction:: Sq. Ft. of First Floor:
G stto# C2 istructio: � $ (o , 6 Utilities: —Sewer —Septic' Building Height:
ame V C IC o
ddress: n f0�
State:
Zip Code: I "16cf- Fax*
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hone No. IQ — .I U
-Mail:
ill in fee simple Title Holder on next age ( if different
from the Owner listed above)
Name:
Company:
Address:
r'ity•
Zip Code:
Phone No
E-Mail
State or County License
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.
Fax:
State:
10
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;...: r:T
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 .
,awffITTe-rii or an attorney before commencing work or recording our Notice of Commencement.
I
i nature g of (5wner/ Lessee racto
/ Contr as Agent for Owner
STATE OF FLORIDA
COUNTY OF S* L( )lc.) -t
SwornAp (or affirme ) and subscribed before me of Physical Presence or Online Notarization
this day of 20_Z�( by
Name of person making statement.
Personally Known OR Produced Identificationy
Type of Identification Produced J�
(Signature of Notary Public- S Ve of Florida )
Commission No. (Seal) , HEATHER BURFORD
=o`"� BState of Florida -Notary Public
_* •_ Commission # GG 183217
P�
My Commission Expires
February 06, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 2 21