HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'j'O BE ACCEPTED
Date: Permit Numb
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Building Permit Application 6i, Woe...��
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:
PROPOSED IMPROVED ENT LOCATibN: r
Address: as fyq )5-,� 'x - &-&6 /'"%
Property Tax ID #: 0 0 / 19ty^ l% Lot No.
Site Plan Name: '1 l-k0 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter_ (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank — Gas Piping _ Shutters -yWindows/Doors _ Pond
x-Electric Y, Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:bJ Sq. Ft. of First Floor:
Cost of Construction: $ riD, 0iV r DO Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: J
Name All-C
Name:
Address: 1 616 '
Company:
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Ale -
City: -(tiC State. �
Address: `100 4>
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Zip Code:7qf Fax:
City:k p1��Cl�
Stater
Phone No.
_
Zip Code:
Fax: t�
E-Mail&�illf✓%�
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail �i
sC
from the Owner listed above)
State or County Licenset"
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: bt Applicable
Name: !C-G
Name:
Address:
Address:
City: , State:
City: State:
Zip: Phoneh7? �Q2- J
T77
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: %I?}tone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain fpermit�So do -the work and installation as indicated.
1 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 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 attornev before commencing work or recording vour Notice of Commencement.
as Agent for Owner
STATE OF FLORLD4I
COUNTY OF
Swor to (or affirmtubsc and sribed before me of ✓ Physical Presence or Online Notarization
thisg Way of Z0�( by
Name of personiKaking statement.
Known
M
ture of Notary Public- State of Florida )
Commission N �'7u g3�C
(Seal)
;o��►�c"�� DONNATHOMAS
Notary Public - State of Florida
V Commission 9 GG 345836
My Comm. Expires Jun'l7, 2023
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
S REVIEW R I REVIEW I V EVIEWON I S REVIEW LE I MREV EWVE