HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll r ;PLICA E FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LC�COrJ ��
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_"" 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Lot
Site Plan Name: n Block No.
Project Name: 13qu A RUTIENC_E
DETAILED DESCRIPTION OF WORK:
ENcRG�N��I p, c. COMICYC
S`lSTCM lnil'fN A 7.5ku,i OfAl
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
AM
_ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Gn l VI, d
z
(Affidavit required)
Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CY
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Name:
Address: 1;(
CLLCY TU
Company:
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City:
Zip Code:
Phone No.
NT L-(A1 LE State: EL
! CFax: �1
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Address:
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City: E
Zip Code:
Phone N
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i State:�ly
Fax:
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E-Mail: Pet m I J ,�12�11GC • GO�YI
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail e- l I1
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State or County License
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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 CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
P
Zip: Phone:
Of
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 C and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit nde or an allorneybefore commencing work or recording our Notice of Commencement.
na ure of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDAe--% ' 1
COUNTY OF IA`M QCK
Sworn tgjQr affir ed) and subscri d before me of Physical Presence or _ Online Notarization
this 15ay of �E [ . 20,2 A by
Cl-+11FQV IL, $AuE
Name of person making statement.
Personally wn OR Produced Identification
Type of I ificat' n Produced
(Sign ure ofrlotary Public- State of Florida )
Commission No. (Seal) o%' ° Notary Public S ate of Ftonda
?° Analisa Whiting
+� a My Commission GG 339912
ero�pd� F�cp,es 05'2912023
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