HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O
VD 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 #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank —Gas Piping _ Shutters
_ Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ ) 0,.01
(Affidavit required)
Generator
Sq. Ft. of First Floor:
/Winclows/Doors
Roof
Lot No. 15
Block No. 2 0
Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Yl
Name:
Address: S4 k/e-
Company: GfeL,_ C\ekC C`CtIS* 6ar.5 - WS QV)
Address: 231-7 5�3c1;jna VRri
City: a�rk �r. e- State: L-
Zip Code: Fax:
Phone No. 7 j2-- '361-1%9_1 9 E-
City: pr. (0", 8-,_a-_i1e. State:
Zip Code: 3331 Z Fax:
Phone No C-15!4) 203 ate f9 yob-�8 i-87�1
Mail: I(.e.y%y%C.:NL_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail_ A.,,•ZJrer _:Lv~A
State or County License C&C \13277 9-75
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.
_ ENT
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name: e
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 ail 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 cWmencing work or recording our Notice of Commencement.
.signafrure or owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO A
COUNTY OF /
Swo(or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
thisr o day of � 20_U by
Name of person makings tement.
Personally Known OR Produced Identification
Type of Identification Produced
re of Notary Public -State of Florida)
Commission No.roe4)3_ (Seal)
REVIEWS
RECEIVED
DATE
COMPLETED
ev 572 T2-f--
FRONT ZONING
COUNTER REVIEW
a
llotary Public State d Florida
Ruth Vatba004A
My Commission HH 116003
Expires 04110/2025
SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW