HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
° 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
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: HH 7-S — --�(7 / — 0(3 Z — D na — Z- Lot No.
Site Plan Name: (b0y {�((,��� 2W&C-
& Block No.
Project Name: / i'
DETAILED DESCRIPTION OF WORK:
\ YI tl nSiZt (1 atccPSSC
li lt" VA52W
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(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
Total Sq. Ft of Construction: 3Z
Generator ✓Roof '( / I Z Pitch
Sq. Ft. of First Floor:
Cost of Construction:$ 2;1. 900, DO Utilities: _Sewer _Septic
Building Height: 10 i
OWNER/LESSEE:
CONTRACTOR:
Name
Name: "D L) I Ge ZQ Y-a
Address: 13N90 Gi l50 n d
Company•--K95 ` v f z4II264 Je00i >`wz*
�
City: 'P�kkI" G f>/ State: EL
Zip Code: 3 ry _ Fax:
Phone No. /I/1A E-
Address:, 116 SE c,✓QGL/eif— SAt
City: 4ya r f State: _r
Zip Code: 3'1 QQ,�L Fax:
Phone No 30
Mail:_ZIA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail D(ni+f;fsl� thPrt_PFa/r�ofe tlX� �s.n�
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
Name: _
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Appl
Name: 1
Address:
City:
Zip: Phone: (�
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has cc
MORTGAGE COMPANY: _ Not Applicable
elty: State:
Zip: Phone:
Name: _
Address:
City:
Zip:
COMPANY: _Not Applicable
Phone:
i is hereby made to obtain a permit to do the work and installation as indicated.
prior to the issuance of a permit.
St. Lucie County makes no representation that is anting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners ssociation 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- Yur failure to Record a Notice of Commencement may result in paying twice for
improvements t J.9r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County ted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend ornev before commencine work or recording vrnjr Nntirp of rnmrnanramcnr
i f Owner/ Lessee/Contractor as Agent for Owner
ATE OF FLORIpA +
YCa M
COUNTY OF I
Sworn to (or affirr�e )and subscribed before me of
�hysical Presence or_ Online Notarization
this �dayof U ti 20YI by
17v1 ce %�
Name of person making statement.
✓
Personally Known OR Produced Identification
Type of Id tific Pro ced
(Signature of Notary ubli t too lorida)
Commission No. �Y?o f Seal
(Sea])
•�yv'>1•., THERESA JAFFE
'a l Commission It GG 2023
?�' 1 Notary Public - state of Fl]Assn.
My Comm. Expires Apr 1,
• • Bonded through National Notary
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