HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L-.L
r, E- @. F,. c C' t'; 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
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
j
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: &� al C� C0 ;�fi
►✓ 1 y'
! //- U 10// v o JL) 51P1 eA � cGt
L
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additio I 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:
�J
Cost of Construction: $ , i 0 F_r2 Utilities: _Sewer � Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 1 N(
Name: I1/ 61-7WA 1 -FL M EJ 1 A
Company: ME✓ 14 AJG L HQ-47/A41 ac -
Address: .Y 2 to M L C RI H
Address: 16 M _5YJ Ac / 2-
City: 1 State: AQ
Zip Code: S Fax:
City: 190k-r 57' L I&C— State•F�--
_
Phone No. J C q 301 ,gL 03.
Zip Code: -9 V9,3 Fax:
Phone No 7.4- • .1Iff 322 0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License_A?R' 0 c! `J
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.
hS\.�-U12'� LC )y:fvT k`Skt'M.',".
�URPL�MRNTAI,�CfJNSTt�UGTI�N,�LIE�[�a:AWttNFY.4
�e°'�%�g'�e
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 attorneybefore commencingwork or recordingour Notice of Commencement.
Aw A
S n ure of Owner/ L ss / ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF %! C/
Swo to (or affir )and subscribed before me of Physical Presence or Online Notarization
this da`y/o�f (IGUs % by
Name of person making staatt ent
Personally Kn n V O roduced Identification
Type of Ide cation Pro
(Signa 1 :forida) ,
Com ' sion "��` ONZAAM
MY COMMISSION # GG349505
EXPIRES: July 01, 2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev