HomeMy WebLinkAboutBuilding Permit ApplicationAII APPTICABTE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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r Building Permit Application
Plonning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: {7721 462-1553 Fax: (7721 452-L578
Commercial Residential
CBDG Funding
Address:0 o n 8e oo/'3{rfZ
Property Tax lD #:
Site Plan Name:
qf//- Yar- oo2s- ooo- Y totNo.62748
Vcnlrr filre<Block No.
Project Name:dtz
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New ElectricalMeter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
Pitch_ Electric _ Plumbing _ Sprinklers * Generator _ Roof
Total Sq. Ft of Construction 7r1q Sq. Ft. of First Floor:ruz_
/foo.oa Utilities: {Sr*", -
Septic Building Height:r"{f
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required
lf value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
PERM IT APPLICATION FOR:0e ,o l; f;0,
PROPOSED I M PROVEM ENT LOCATION :
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OWNER/LESSEE:CONTRACTOR:
Na
Address #
City:State: F/
zip coae: 3/?5 7 Fax:
Phone No. 7/ j'q/7- /777 E
Mail
Fill in fee simple Tatle Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address: /6/
City:ao State
zip code: 3{?57 rax: 772- 2j2'Ltfl
Phone
E-Mail
No 7 0-,
State or County License c0c t2 vr/
. €02t
Permit Number:
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X
CONSTRUCTION I N FORMATION :
Cost of Construction: $
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UCTION LI EN LAW INFORMATION:
MORTGAGE
Name:
Ad
_ Not Ap
Ph7ip
City:
Address:
Name:
_ Not Applicable
Zip: _Phone:
FEE SIMPLE TITLE HOLDER:
Address:
City:
Zip:
Name:
licable
Phone Phonelip:
Name
Address
City:
COMPANY:_Not Applicable
OWNER/ CONTRACIOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv makes no representation that is grantins a permit will authorize the permit holder to build the subiect structure
which conflicts with anv applicable Homeownerslssocialioh rules, bvlaws or and coVenants that mav restrict or prfihibit suchstructure. Please consult With your Homeowners Association and feview your deed for any restrictions which may apply.
ln 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 foltowing 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: Yourfailure to Record a Notice of Commencement may result in paying
improvements to your property. A Notice of Commencement must be recorded in the
Lucie County and posted on the jobsite before the first inspection. lf
with lender mme or recordi
you intend to obta
ur Notice of Comm
twice for
public records of St,
in financing, consult
r€Ilc€fi]€ht.
Signatu ctor Agent for Owner
STATE OF FLORI '?vlw *UCOUNTY OF
---hnysica I Presence or _ Online Notarization
this of
Name of person making statement.
Personal Known OR Produced I L,LofProd
*"
ry Public- State of Florida)
Commission N,.v G ) aSoo ) dill:% JESSEDoss
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REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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