HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE
"yINFO
-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "i I l i 2- I 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 CBDG Funding
Address:
Property Tax ID #: 2-�SG ���1� �� �iG (� > Lot No.
Site Plan Name:�Block No.
Project Name:
gill
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 Z- Pitch
Total Sq. Ft of Construction: 2 �41 Sq. Ft. of First Floor:
Cost of Construction: $`:1-7
_ C)() Utilities: —Sewer —Septic Building Height: 2-0
OWNER/LESSEE:
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 Z- Pitch
Total Sq. Ft of Construction: 2 �41 Sq. Ft. of First Floor:
Cost of Construction: $`:1-7
_ C)() Utilities: —Sewer —Septic Building Height: 2-0
OWNER/LESSEE:
CONTRACTOR:
Name
1
Name: � -�
Company:
Addres
fn'3
/1
Address: .'3'RCJ1 Ic" � J l
*
City: if, k Ce, State:
Zip Code: Fax:
Phone No. E-
Mail:
City: \Y VC C
Zip Code:
Phone No
k. State:
Fax:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
a
r )
State or County License
' ,
n .. - VI 4.VI L.UUL1UpI 1)� Lauu up 11pup C, a nr%.unuru rvouce oT Lommencement is requirea•
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable I MORTGAGE COMPANY• Not
Name:
Address:
City:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
. pp Ica e
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Applicable
...,,,, I wry i nmo- i vn mrriuvi i : 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, 1 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 cnmmpncino Wnrk nr rarnrrling ni +,, , ,.r
-- ----...---.._... .......... ......,W'vUl JMUL1%,U V%,U11111ICflLerrlerit..
Signature of Owner/ Lessee Contractor as Agent for Owner
STATE OF
COUNTYOFORIDA
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 21 by
Name of person making statement. -
Personally Known _ OR Produced Identification
Type of Id tification Produced
MIK[7��A
-
(Si atur o ary lic-St orida)
}
Commission No. SealKATHERINE HAVENS
My COMMISSION.#GG165030
;14
EXPIRES: DEC 04, 2021
Bonded through 1st State Insurance
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev