HomeMy WebLinkAboutB3uilding Permit ApplicationAll APPLICABLE INFO MUST BE CC LETED FOR APPLICATION TO BE ACCEPTI'-
Date
Permit Number: cp- Lc), I- -
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
PERMIT APPLICATION FOR:
Site Plan Name:
Project Name: _
a"'l%a
New lec ncaI Meter ---Second Electrical Meter (Affidavit required)
Lot No. 101
Block No.
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters. _ Windows/Doors _ Pond
_ Electric _ Plumbing _Sprinklers _ Generator _Roof Pitch
�FtofGon_st-uc~-t��i Sq. Ft. of First Floor:
L�os'f Co�rsstrucion�pa Utilities: _Sewer _Septic Building Height:
fume^ �'�C.� ,41i_k _fo Ca -IQ►uac,,
Oddress: . 1A G&06c, 1QV�
y: F/lYa eXca State: YL
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;� Code: y I�I� Fax:
hone No. :331 •-1�0�—� �
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in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
Citv:
Zip Code:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORD'E-S Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is requir d.
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Fax:
State:
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DESIGNER/ENGINEER: _ 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 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 Hoi ' 60wners Association 'rules, bylaws or and covenants that may Irestrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed -for, anyrestrictions yvhich 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 yl'iork or recording your Notice of Commencement.
nS`" te�afrGdwner Lessee/Contractor as Agent for O er
STATE OF FLORID;t,_
COUNTY OF C�
Sworn to (or affirmed and subscribed before me of Physical Presence or Online Notarization
this day of 320A-A by
1 y ^ n
Name of person making statement.
Personally Known OR Produced Identi tiQQn
Type of Identification Produced —L
(Signature of Notary Public- State
,o"pvP� ELLEN VAUGHN -
O'gl�tate
Commission No. ?2°�P
of Florida -Notary Public
_' •= Commission # GG 270079
MY Commission Expires
October 22, 2022
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