HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLI,
Date: �O
Planning and Development Services
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 10,9 51 5nuA QCZAn D1'iUP, L
FOR APPLICATION TO BE ACCEPTED
Permit Number:,Z/ 6
Building Permit Application
SEP 17 zoz�
Res i d.eaRtigI
qt. Lucie Countyent
RECEIVED
Property Tax ID #: L15 1 1 ` 4 13 - OOd 1 - .510 - r Lot No.12 S_
Site Plan Name:
Project Name:
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprink ers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: \� Sq. Ft. of -First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
Name -7-t es L UP boWe C
Address: loin-5 So, Oceov LoU 3
City: _T" S co e_eCA State: VOL
Zip Code: M Ij,.5 r% Fax:
Phone No. 5 6 f' WOO (15 7
E-Mail: -Af i'n 3e-� ovWeSG1 a)" 60 M
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: SLtp erior _ -_-h
Company:
Address: 6f r?5 S U 5 I
City: State: fL
Z'ip Code: Fax: 772- �(90 4601
Phone No 7 410
E-Mail 5 r
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.
Not
DESIGNER/ENGINEER:.
_
Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip- Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ 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 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 attorney before commencing work or recording your Notice of Commencement.
1
er/ Lessee/Contractor as Agent for Owner
STATE`Gr1 FLORIDA
COUNTY OF
Sworn to (or affirmed)and subscribed before me of /Physical Presence or Online Notarization
this A- day of 20-,f/ by
Name of person making statement.
Personally Known OR Produc I entification
Type of Identification Produced
of Notary l5_6bliQ?Xtafe of Florida )
Commission No. (Seal)
HEATHER BUR Fp
State of Florida Notary Publi
COn1M'sSiOn # GG 183217
MyCoMMisslon
REVIEWS FRONT ZONING SUPERVISOR PLAN SEATURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED