HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t Oj
( 1 t�2 C3 z t Permit Number:
Lo 40404
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A 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
PERMI I mrrLICATION FOR:
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NO
Address: � 5 � � "(�Of (X Y I ✓t it � i2 .
Property Tax ID #: I Li I S D- U 0 CQ ' CX)o t Lot No.
Site Plan Name: "NP o horse (aJ erAc," 13 U Vi [3 ck t t> yo S Block No.
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New Electrical Meter Second Electrical
Additional work to be performed under this permit —check all that apply:
chanical
Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
_Gas Piping
_Sprinklers
Cost of Construction: $ � s °-C �' � •
_Shutters
(Affidavit required)
_Windows/Doors _Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
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Name
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Name: r r
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Address(: P.0. 6o� CnI 3 99
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Company ) ._(-e. Fe
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Zip Code: ..32. `� in Y Fax:
Phone No. '1 1 2 3 2 i- �rs
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State: P .
Address: Cs3 "l S-ebk5 h
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City: Sp to h �u�
Zip Code: 3 2 G( S 9 Fax:
Phone No "l 1 2 3 q,8 %
State:
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Mail:
Fill in fee simple Title Holder on next
from the Owner listed above)
page (if
different
E-Mail aO-u� evyS+ f i �
C ow�oi2le
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State or County License L earn® k9 F 1
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 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 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 beforecammencing work or recording our Notice of Commencement.
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Signature aMW-nerd Lessee/Contractor as Agent`fio-r-Owner
STATE OF FLORIDA
n'
COUNTY OF
Sworn.p (or affirmed) and subscribed before me of ( _Physical Presence or _Online Notarization
this day of _J 20 by
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Name of person making sttateFwrneot.-=
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
�' Florida
Commission No. r.,.<� (Seal) Notary Public - State of
' `a� Commission # HH 028294
`�?',or r�„° My Comm. Expires Sep 19, 2024
bonded through National Notary Aszn.
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