HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFFOOf MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: -I v ` Permit Number:
7. r RECEIVED
Building Permit Application
Stf� o n 1
Planning and Development Services
Building and Code Regulation Division Commercial Residential Per in D
�t
Lucie
dour;
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: -�. v� a .�`� -' O r C' C Ge r_.
�1�" Lot No.
Property Tax ID #:
Site Plan Name: Block No.
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Project Name: Act.( C� <, t r1 c •�
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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 _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $/ Utilities: —Sewer _:Septic Building Height:
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Name
Name:
Address: c7XR .0 2_Cx Ck-`P--
Company:
City:ci�C�/—b�� c' C Q �-- State: _
Address:
Zip Code: `'[ [ Fax:
City: State:
Phone No. ?kq
Zip Code: Fax:
E-Mail: \y-\ -1v;-e_\k_eAC)1_7
Phone No
IC
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
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.
(L-S 4 � 7) jq 16 61 1�_ 91 C,61r S
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 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 erty. A Notice of Commencement must be recorded in the public records of St.
Lucie Co my d po ed o the jobsite before the first inspection. If you intend to obtain financing, consult
with le er r n attorne efore commencing work or recording our Notice of Commencement.
X_SigNture/f Own Lesse /Co ractor as Agent for Owner
STATE OF FLORIDA�
COUNTY OFd2—
Sworn to (or affirme ) and subscribed before me of J Physical Presence or Online Notarization
this,- day of 20'!;"`o-y
Name of person making statement.
Personally Known OR Produced Identification
Type of [dent* ication Produced cS2_
(Sign u eofNotaryPublic- to o lurid ) �e,,� HEATHER BURFORD
�=State of Florida -Notary PublicCommission
No. (Seal) Q Commission # GG 183217,My Commission Exires
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% february 4i6, 20 2
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