HomeMy WebLinkAboutBuildng permit app, uptdatedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �] i
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:
PROPOSED IMPROVEMENT LOCATION: �
-GO,
Address:.'
Property Tax i D #:� 0 O Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
IVoa
UAA2 Lu ��CA C Cps
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 w Gas Piping Shutters Windows/Doors Pond
Electric VPlumbing Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�'�
Cost of Construction: $ C"4kft .�_ ..�_._ Utilities: —Sewer — Septic Building Height:
OWNER/LESSEE:-CONTRACTOR: i
Name !i1 U..� Name:
Addres 4. 04 N' + Company:ls
i city:Ct, State: Address; krbT
Zip Code: � Fax: City: State:
�� °� E- Zip Code: �� Fax:
Phone No.
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail '`�sti� ;
i from the Owner listed above) State or County License t
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 LIENLAWINFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 conflicts with any applicable Homeowners Association 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: 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 If4mriQr or an attnrnPv hPforP r_ommencing work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and subscribed before me of _V_Physical Presence or Online Notarization
this ;�O day of 20c>1 1
by p. we s4,Ps e...
Name of person making statement.
Personally Known" OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No.(" I IP-3 � (Seal)
State o� F'.0%a
Cc+*T+ssicr. ;9 GG 163244
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DATE
RECEIVED
DATE
COMPLETED
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Kev 5/lu/11