HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COP ,:TED FOR APPLICATION TO BE ACCEPTEI' ,,
Date: Permit Number:A 6 C6- Q vry9
°W11Building 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
PERMIT APPLICATION FOR:
Address: U �IJ U'i- M I v1 rul
Property Tax ID #: :-56) Q�0- C Lot No. /0
Site Plan Name: Block No.
Project Name: W k, H11 CLA f-�)a i rC/a
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit -chock all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 'A"-)y Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height)-l7
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Name... `� a , 14w r .
Name:
Address: 6� U GS(Y�1 y'_°°b... _ . �
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City: 'CrState: _
Zip Code: Fax:
Phone No. ��.� " �� %�
Address:
City: I(e- Stater
Zip Code: �J�� Fax:
Phone No q5Y 575:9-�%
E-Mail: I9 0 I 4rd - U 0
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0
K,1 CUM
State or County Licenseepl)e
If value of construction is Z50o or more, a RELUKUtU Notice or l0Mn1encemer1L is Fcyuii cu.
If value of HAVC is $7,500 or more, a RECORDED notice of Commencement is required.
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DESIGNE NGINEER: _Not
Applicable
MORTGAGE COMPANY:
_Not Applicable
Name:
Name:
Addres : � G,l/t�!�
Address:
City:
Stater'
City:
State:
Zip: Phone
%L
Zip: Phone:
FEE SIMPLE TITLE BOLDER: _
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 Build.ing 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 attorn fore commencing work or recording; your Notice of Commencement.
Mire of Owner 'Lessee/Contractor as Agent for Owner
STATE OF FLORIDA,)
COUNTY OF ! aC+��
Sworn to (or alfn
ed) and subscribed before me of __—`J Physical Presence or Online Notarization
thiscb day o 2,0PL4 by
Name of perso"making statement.
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
COMPLETED
SUPERVISOR I PLANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW