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 Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: P1,1% 1.
PROPOSED IMPROVEMENT LOCATION:
I
Address:
Property Tax ID #:��� �" ��) - Lot No.
Site Plan Name: N w Block No. C
Project Name: b, I I �)
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter
Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Windows/Doors
_ Electric 'Y Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $"ti 7 • `` Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name i ( cly- C Cineak "
Name: r'—<� mac
Address: jay � ���"_
City: Y , E1 State EL
Zip Code: Fax:
Phone No. ' )�+ `4 "" f�c),;�, E-
Company:
Address: I1431 Lor—t 6rw__
City: <' "-' - -� _ State: i ;C
Zip Code: �)qq:s` '
Phone No 'n c� , 1� _ �1) 1
Mail: r'`', � { - CC)_n^�
-�c�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License,'
If value of construction is 2500 or more, a RECORDED Notice or LOrnmencemem: is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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:
BONDING COMPANY: Not Applicable
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 any 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,
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 attornev before commenciniz work or recordine vour Notice of Commencement.
Signatu e OfO ner/ Lessee/Contractor as Agent for Owner
f
STATE OF FLORIDA
COUNTY OF�:�°t,
Sworn to (or affirmed) and subscribed before me of +�
Physical Presence or Online Notarization
this i _�I, day of Sc__--a- t y6-g_j— 20 by
Name of person making statement.
�1►►r Notary Public State of Florida
Cheryl Fowles
Personally Known OR Produced Identification
My Commission HH 116177
Expires0a/11/2025
Type of Identification Produced�osa'
r'
(SignaturgM Notary Public- State of Florida)
Commission No. ! l (Seal)
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