HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential
IV)
L PROPOSEDttI ,MPROVEMENT,LOA/CATION:
Address:`-C! (w"I
Property Tax ID #: iC( . (� G-- Lot No.
DO
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter 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 , �-( Pitch
Total Sq. Ft of Construction: �l1 k C)C.) Sq. Ft. of First Floor:
Cost of Construction: $ V-2- i Ci ---1-5 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name <�k PA
Address:
\ 1
;p it r-�- Y i C
r-<-- V
Name: J�A , (: 'l (A eA i ✓
Company:T4A J _P_ 1 r)
Address%U
City: `+'1 Li
Zip Code: (;
Phone No. "`)'
Mail:
State: C
Fax:
b9 3-5 E-
Cit Y: `,--
""'r- V\ t State:
Zip Code:�7��1 C) Fax:
Phone No 37a - C']� Lo U -- �
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail m + K..2 �S-�'►-r (Q \.� I l��# _�,�f�t;°� -(
State or County License (_c ( J m
wuuw U1 %.ummencemeni Is requlrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 any 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 leryder or In attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF Lk-.tr C_ i
Sworn to (or affirmed) and subscribed before me of `-Physical Presence or Online Notarization
this .I�eiay of A— 20 2-) by
(_�k , , (t £ ) C_-e _ v
Name of person making stat7ent.
Personally Known OR Produced Identification
Type of Identification Produced A
(Signature of Notary Public- State to
Commission No. `�� (o'3'R�
(Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
'6Smy&o Felicia Lyne wilkin
oar °° NOTARY PUBLIC
a -STATE OF FLORIDA
l Comm# GG103860
Expires 9/4/2021
SUPERVISOR I PLANS I VEGETATION I SEATREV RILE I MANGROVE
REVIEW REVIEW REVIEW