HomeMy WebLinkAboutPERMITAIIAPPLI MUST BE COMPLETED FOR APPTICATION TO BE ACCEPTED
Date:
St" LIJ€ilH
Building Permit APPIication
Plonning and DeveloPment Seruices
Buitding and Code Regulation Divisian
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: 17771 462-L553 Fax: {77?1 462-L57 8
Commercial v Residential
CBDG Funding
Address:
Property Tax lD #:,-l ll aoa Lot No
Site Plan N
-+VO Ni t h)(-),\
Project Name
PERMIT APPLICATION FOR:J
I< {CL
*
Fax:
State:
State or Co unty Lice
Company:
Name:
City
zip
Phone No
E-MailFill in fee simple Title Holder on next page
${/tq
Name
Ad d
Fax:
E-
{if different
from the Owner listed above)
Zip Code
City:
Phone
Mail:
{l.+i( <
New Electrical Meter
-
Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit - check all that apply:
-Mechanical -
Gas Tank
-
Gas Piping
-
Shutters
-
WindowsfDoors Pond
Pitch_ Electric _ Plumbing
-
Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: $l rCtJo
a* €?
Utilities:
-
Sewer
-
Septic Building Height
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required
lf value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is required.
DETAILED DESCRIPTION OF WORK:fi/L
u l-: l;
LOCATIONPROVEMENTIMPROPOSED
1
i
U I
City: State:
-
-
Not ApplicableMORTGAGE COMPANY:NEER:
Name:
zip:
licaNot
ress:
State:
Phone
Add
City:
-Not
Applicable
City:
7ip:Phone:
Name
City:
-
Not Applicable
Phone:zip
FEE SIMPLE TITLE HOLDER:
OWNER/ CONTRAI[OR AFFIDVIT: Application is hereby made to obtain a permit to do the
I certify that no work or installation has commenced prior to the issuance of a permit'
work and installation as indicated.
i,'i[Tft1fiffi.?:r,,infiTil:r"ilJ,"fi""I1',\s!"l,xi:i:fl,1,1'1i.",1R?',j1xl,!l''i#:%",1i.:.:ta'if,is!!ii$%:??3{# l!?i[,?i!,:'!iJ"t'J#,."
structure. ptease consuiti[iiiiT;"; ii5ii.iE5*il|; i#;;;i;ii;; ini-ievieil'votjr deid]oi any restrictions which mav applv.
ln 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 lpprorEa 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
be recorded
paying twice for
improvements to your p roperty
on the
A Notice of Commencement must in the public reco rds of St,
Lucie County an d posted jobsite before the first inspection. lf you intend to obtain financing, consu It
with er or an before com work or ur Noti ce of Commencement.
ntractor as Agent for Owner
STATE OF F 4z\:lt,-c,^.-q
COUNTY OF
Sworn.tothi+L {or affi bscribed beforezeit
-t
me of Physical Presence or
-
Online Notarization
of
Name of person making
0R Produced ldentifi cation
Type of I on Produced-T
(Signature
Commission
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SGllRGNAI
PuNdaoil-lcrt r),oetat;q 0 0'):
t-l G(jSSaITlM(l o $qlnExnliltSIoCoivl
2 12DM
SEA TURTLE
REVIEW
MANGROVE
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SUPERVISOR
REVIEW
FRONT
COUNTER
ZONING
REVIEW
REVIEWS
RECEIVED
DATE
COMPLETED
SUPPLEMENTAL CONSTRU LIEN LAW INFORMATION:
zip:
BONDING COMPANY:
Personally Known
Notary Public- State
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