HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�Lrli� �Pi5_1 W 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: 2>Wb
Property Tax ID #: LAa` Le ` Z> 10' 0 Q D `i ' O 00 - 0 Lot No.
Site Plan Name: i>l eC S - Dt y1% �� 3- 5 Block No -
Project Name: P_(�''lp�—['
DETAILED DESCRIPTION OF WORK:
R_
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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
Total Sq. Ft of Construction: pp��
Cost of Construction: $ 155 O.00
Sq. Ft_ of First Floor:
Utilities: Sewer —Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
--
Name n
Address: 1 ui ' kOvL60vva 1_% GI�, 2>Q�
dame: Auk 2+pcG64�
Company: xC �rp -AQ'r OAZBLtkt
City: R\vsf\ LL`# State:F�.
Zip Code: (Ao►otO Fax:
Phone No. E-
Address: qMD 5E �.�
City: ��1� FL�t State:IFL
Zip Code: Fax:
Phone No-Y) o`Z0_ O aUI LP
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name: _
Address:
City:
Zip:
Pho
FEE SIMPLE TITLE HOLDER
Name: _
Address:
City:
Zip:
Phone:
State
4 Not Applicable
MORTGAGE COMPANY:
Name:
Add ress:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
—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
improve is to your roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie Co nt and os on the job e before the first inspection. If you intend to obtain financing, consult
with len er r a t r e before c mencinga work or recording our Notice of Commencement.
Signature of bwner/ Lessee/ tractor s gent for Owner
STATE OF FLORIDA `
COUNTY OF l( NQJN I tJ
Sworn to (or affirmed) and subscribed before me of V physical Presence or Online Notarization
this ,a— dayoff, \ 20p%l by
+AcdJ ti
Name of person making statement_
Personally Known ✓ OR Produced Identification 1111111kNPlly�
Type of Identification Produced
(Signature of Nota
blic- State of Florida)
Commission No. q6 O(_042 ` (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
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SUPERVISOR I PLANS i VEGETATION 5 R TURTLE � MREVIEWVF
REVIEW ` REVIEW REVIEW