HomeMy WebLinkAboutdesdune permit applicationA
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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:
Address:�t� n�X1�`/��l�bY
Property Tax ID #: 5331- - C M� off/ Lot No. qt )
Site Plan Name:�SMVc'p2�- R)QtY— (1 0-1 Block No.
Project Name: D2�wr)e—
New Electrical Meter Second Electrical Meter (Affidavit required)
CONY T'RUCTION=.INFORIVlATIONI.
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:
Cost of Construction: $J,3150 Utilities: -Sewer _Septic Building Height:
•OWNER/LESSEE:
CONTRACTOR "
a'
Name
Name: Q ��
Address:
Company:
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city: (Tl� • F�nC\P, State: (,
Zip Code: ? �4q -e Fax:
Phone No -I-I-J L (kp k (Ia _0 E-
Address: Sri I W
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Clty:pr' f �-\AC NE State:
Zip Code: Fax:
Phone No —\712i
Mail: N A
FIII In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License 18(
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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.
SUP,PCEMEN�LCQNSTftUGI„ONL`IEI�*L/XUF)MFOR�ti,{�710Nr"°",�;`' yg
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 grantin 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 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 nr an attnrnev hefore commencing work or recordine vour Notice of Commencement.
Signature net/ Lessee/Contractor as Agent for Owner
STATE OF FLORID�A � 1
' ,
COUNTY OL]F �t CGe.
Sworn to (or affirmed) and subscribed before me of x Physical Presence or _ Online Notarization
this2Y'aday of ! 2.MWC 20ak by
Name of person making statement. os e�
Personally Known Y, OR Produced Identification
Ty of Identification Produced,, ,^, __�
YAr�/i V ' 1 LUC,) "r
(Signature of Notary Public- State of Florida)
Commission NOGZ7_c F�n1Y / 4al) „ bb, SHARON MILLER
•4;^ate Florida -Notary Public
�O"" Stateof
202177
'-•Commission#GG
My Commission Expires
Apri101,2022
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