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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 10S1
Property Tax ID #: - $O3 ' C70L�'--J - 0C)a - Lot No.
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Site Plan Name: Block No.
Project Name: --e A-i6 dta-&-i W
"DETAILED DESCRIPTION OF •'
FPW.4, F 1E
YJ"W0"""0_'F WIT 51, FPOO�AM-Aro.
% % W Aid ' 111111 i►i�� �i i vcal
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�:• 'I. •fir. [�.► Lis.11 �i
New Electrical Meter • • Electrical Meter
CONSTRUCTION INFORMATION: "�� .
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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 V/ Roof Pitch
Total Sq. Ft of Construction: Le600 Sq. Ft. of First Floor: •2s
Cost of Construction: $ 45'5-00 Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE
CONTRACTOR:
Name 04 izw,
game: QviSiny
Address:�b�l P1�r 1�►�.
Company:
Citylvy'(� State:
Address: -7C) S A -le .
Zip Code: q,4f12Ce Fax:
City.61yt vq- State: e7.--
Phone No. ''77 Lkt�q �C O
Zip Code:3Lt1�1q'1 Fax:
E-Mail: i
Phone No'777i 2in i C'�
Fill in fee simple Tit a Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License cl
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. -
DESIGN ER/ENG IN EER: Not Applicabl
MORTGAGE COMPANY: Nop4plicable
Name:
Name:
Address:
Address:
City: tate:
City: State:
Zip: Phone
1110,
Zip: Phone:
FEE SIMPLE TITLE HOLDE Not Applicable
BONDING COMP 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 is in conflict with any applicable Home Owners Association rules, bylaws 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 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 commencine work or recordine vour Notice of Commencement.
n/ , -2
Signature of Ow Less a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF jooAa_Q'%h V-%
Sworn t (or affirm d) and subscribed before me of Physical Presence or Online Notarization
thi4anay of 2M by
Name of person makin statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING REVIEW I SUPERVISOR REVIEWI PLANS REVIEW I VEGETATION EVI WI S REVIEW I MANGROVE