HomeMy WebLinkAboutBuilding Permit appAll APPLICABLE'INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �' 11�?))1
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential d
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 00r,,CW46Pf.,KC.0
RRO,P,IT, IA *_#�EM�ENT LO 00119, :
Address: 70� vu s r L U r ,e rc Ic 3 S-
Property Tax ID #: 1 • No.���
Site Plan Name: Block No. S
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Project Name: Co ['' ?� K 114! svete®� t
D'L�1'AILED DE=�5CRIPTI�N�.�:F WORK: `.
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTIONINE®R11lI/1TION:
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
f- .n_
Total Sq. Ft of Construction: f Sq. Ft. of First Floor:
.Cost of Construction: $' a0 Utilities: —Sewer Septic Building Height:
OU1`/NE ; jL = BE:
*ONTRAC�T'OR:
Name ig 7 E p
ame..
Addre��sss: -7b 1 Lo GIV
Company:
City: t' 1 YG'e- State: �L
Address:
Zip Code: .15-dd Fax: g
Phone No. — 5T —
City: State:
J E-
Zip Code: Fax:
Mail:-&4 rC i LL,. CBV"
Phone No
Fill in fee simple Title Holder on nex page (if different
E-Mail
_
State or County License
from the Owner listed above)
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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IPPLRMENA CONST#tJCTION LIEN LAW INf=+.RMATIO `
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
th lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Wherl Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �" 1C�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of, 2o�by
are
Name of person making statement.
Personally Known OR Prod d ld�if'con
Type of Identification Produced
(Signature of Notary Public- State o F
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Commi iF ' I ;, �S�li public =o apTA
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Rev 5/20/21