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HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: cc�O L L 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: Address: i., ,��� e r `C eu-\ �L L Property Tax ID #: © 00 ©� Lot No.�L�`, Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: U ened rr_erwy eo Rev-, (j J e , C,n,e r, New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: Additional work to be performed under this permit —check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Electric _ Plumbing _ Sprinklers _ Generator _ Windows/Doors _ Pond _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Vrs Utilities: _ Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Lx' jr(- G �_'c Name: ` �� -- tt Address: � ��� �bu �� (_4 U d4 ���1� Company: City: LL, P State: Zip Code: 4� Fax: Phone No. E- Addres �9 cC L �r 4 Q a City: �61 F , L ( A ((Q State: Zip Code: Fax: —T- Phone No Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail State or County License IT Value oT Construction is ZWU 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 I_If.N I AW INI ORMAHON: DESIGNER/ENGINEER: Not AppIri ,able Name: Address: City: . State: Zip: _ Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY Name: Address: City: - State: Zip: Phone: .____ _. --- Not Applit.,ible BONDING COMPANY: Not nlrltlic,)trl(, Name: Address: City: 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 reppresentation 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. Luci o tnt nd posted on the jobsite before the first inspection. If you intend to obtain financing, consult wit I n Or an attorney before commencing work or recording _y_our Notice of Commencement. Signature of actor as Agent for Owner STATE OF FLORID COUNTY OF � Sworn to (or affirmed) and subsaibed helorn, nip Al V Physical Presence or Online Notarization this a day of .-_.C)L- N_C)eJ- , 20 Z-\ by . tbA 1 G' S\ \CkS 7�1 Name of person making statement. Personally Known V-.*"OR Produced Identification Type of I tification Produced—______._ (Signature of Notary Public- State of Florida) w �/� 2Sa43g Commission No (Seal) :"'w • AMANDA ADAMS �': ; MY COMMISSION S GG 259439 EXPIRES: September 17, 2022 Qod.. Bo,,&d R. Notary PuDNc UMI-ilea REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE ----- -- - RECEIVED DATE COMPLETED