HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 00t �( ) Permit Number:
S-t LUaL
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: Ejeq (C00
Address: SYO Sl1(`iri--'.k l7Y Ey- P)1 fce (-- — S�-ia�rJ
Property Tax ID #: LDol- ON - q Lot No. a S9
Site Plan Name: Block No. C
Project Name:fOw�
DETAILED DESCRI
R`E�IUC �iS�C\ W \ (XXs , nod, h ,
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:
Cost of Construction: $ ) 53(.Q Utilities: _ Sewer _ Septic Building Height:
OWNER . • _ , .
Name kiYX) ti VN Name: Ca 1'1`C1
Address: �-10 �L(lY1SC' (�r . Company: ?�V)K'Y( e)PC+`IIC
City: �i PietCf' State: Address: � 1 >X '��, S
Zip Code: Fax: City: yJa l� tk6 State:
Phone No.%'l 6) - �14- a�nl� E- Zip Code: Syq F-D Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail V 1
from the Owner listed above) State or County License ac I 3
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.
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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 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 deed for
your 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF L-U('je.
j/
Sworn to (or affirmed) and subscribed before me of / Physical Presence or Online Notarization
this.l day of a,)M�-ff __, 203.1 by
Name of person making statement.
Personally Known OR Produced Identification
Type of nt�ication Produ e
. �� GiO ✓
(S gnature of Notary Public- State of Florida)
ALISON HANSON
�
Commission No.669-100'-13 (Seal). .: MYCOMMISSION kGG970043
EXPIRES: March 16, 2024
Bondod Thru Notary Public Underwdters
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