HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 C 2 Permit Number:
�1aILLCM �.,
° �0 °0, ' Building Permit Application
Planning and Development Services-'
Building and Code Regulation Division Commercial ResidentialJZ
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address ii C `a 6 i Y C' C' t 1 1 e L<C , �-� • �$ �
Property Tax ID #: C t l ( ou c� I 0 0 0 "' Lot No.
Site Plan Name: Block No.
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
.Mechanical
.P Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Gas Piping
_
_Sprinklers
Cost of Construction: $
_Shutters
(Affidavit required)
Windows/Doors
�7
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
�.,6CA
Name X) (
Name: CsM?i
((rL
Address: C? �C3C{ I
_� A�F%
Company: �f
t%l 9lhViC �,C
City:y2n OL bin
State:
Address: &o�tdfI
S i,6L
,�
City: a S
State: FLL
Zip Code: _ 3 t
GFax:
G
Phone No, 6 6 ®
s`P! (.3 E-
Zip Code: ,52 15 Fax: 1"'j2 ~��►19
Phone No_'(�
Mail:
Fill in fee simple Title Holder on next
page (if different
E-Mail_
H-,,# r /
from the Owner listed above)
State or County License f 8 ti
lJ l
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.
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 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,
accessary 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 attorne fore commencing work or recording our Notice of Commencement.
Sign ner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
�r
COUNTY OF e%.Ip\
bef :/Physical Presence Notarization
Sworn tp (or affir ed) and ubscribed re me of or _Online
C� day 20 by
this of
it (i._i
Name of person making statement,
IN
Personally Known LI, OR Produced Identification It
COURTNEY E REGAN
Type of Identification-ProoidUced Notaypublic-stateotFlo
,'; da
Commission,# HH 028294
'1
c My Comm, Expires Sep 19, 2024
o ary ssn.
(Signature of Notary ublic-Stta e of Florida)
Z'fi� B OURTNEY E REGAN
Commission No. (Seal) Public - State of Florida
Em"��
mission it HH 028294
m. Expires Sep 19, 2024gh
National Notary Assn,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev