HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST i COMPLETED FOR APPLICATION TO BE ACCEPTED �
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Date: ��' Permit Number:
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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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
_
Address:
Property Tax ID #: 060 Lot No. �d
Site Plan Name:
Project Name:
------ -
DETAILED DESCRIPTION OF WORK:
(���A�� 5_0 Gil
T
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: Sq. Ft. of -First Floor:,
U
Cost of Construction: $ l2 Utilities: _ Sewer _ Septic Building Height:
OWN E`RAESSSSE E:
CONTRACTOR:
Name 5 ,HIV/t C t PA``L
Name: �� v'Yz
Address:n_L /ivl/
Company: P7A ✓�o U ✓� �� `y�
City: 1 S L State%
Address: /7 2 P �A'k &
'
City: _
State:(\
Zip Code: �iy G! S L Fax:
Phone No. -
Zip Code: af I Fax:
E-Mail: -- --
Phone No %7 2-
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requir
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. 6Y
-
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 f
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 bylaws
rules, 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 pl , the Florida Building Codes and St. Lucie County Amendments.
The following building permit a I' atio are exempt from undergoing a full concurrency review: room additions,
accessory structures, swi mi ools nces, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OW R ur ' r o Record a Notice of Commencement may result in paying twice for
improvemen to ur pe y. A Noti e of Commencement must be recorded in the public records of St.
Lucie Count an ost on e jobsite of re the first inspection. If you intend to obtain financing, consult
with lende r att ey ore conymepcing work or recording our Notice of Commencement.
i
Signature Owner/ Lessee/Contractor as ent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me ofical Presence or Online Notarization
this /4_ day of 204 by
iName
of person making statement.
Personally Known OR Produced Identificationy
Type of Identification Produced']
(Signature of Notary Public- e J Florida )
Commission No. (Seal)
1P0.Y P(B
"" HEATHER BURFORD
`�= State of Florida -Notary Public
_• •= Commission # GG 183217
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bruary 06, 2022
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