HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
g T 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: t I ec4-vica-1
PROPOSED IMPROVEMENT LOCATION:
Address: 3001 �Ycpb 1s 8 , T6(4- M, YACA51
Property Tax ID #: 1 c1•� - 1 bi�0 `i - aw - Lot No.
Site Plan Name: f /1 Block No.
��t
Project Name: t t.P�WDoa 1�'M'M_T'np_
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter,
(Affidavit required)
I CONSTRUCTION INFORMATION: ,
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters _ Windows/Doors ^ Pond
% Electric r Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ i s q 00 Utilities: _ Sewer r Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name D S fie.
Name:
Address: 3001 -16ho MM
Company:
�
city: br+i QCce State:.
Address: 3'%5 619AtrU NIP
Zip Code: ��495 I —Fax:
City: J State:
Phone No. V-1iC9 - 93q -g a I a E-
Zip Code: �LkCA tT 2j Fax: --
Mail:
Phone No *y-MvZ- j'i02.- y9 ( I
E-Mail w Mo►��
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License FC 1 :3 OO 011
if value of construction is 2S00 or more, a RECORDED Notice of commencement is requireo.
if value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC171ON LIEN LAW INFC}RMATION '
DESiGNERANGINEER: _ Not 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 Counter 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 art,,a efore cc xna: t ncing work or recordine your Notice of Commencement.
STATE OF FLORIDA '`' •
COUNTY OF__&&c ire'
Sworn to (or affirmed) and subscribed before me of
this j4 day�n c,/ of Ufa f>e r 2U�2lr by
aGl✓y-17�1 ki 1 I i '
Name of person
Personally Known )_ OR Produced Identification
ryRe of Identification Prgduced.
(Signature of Notary Public- State
of Florida)
Commission No. —A 7�Q5,J (Seal)
Physical Presence or Online Notarization
MY COMMISSION # GG 197659
EXPIRES: March 19, 2022
Bonded Ttw Notary Public ftemiters
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