HomeMy WebLinkAboutAgnew permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
S W La a
Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7e> 2z,,1,,= 6 t �, �,
Property Tax ID #: Lj as - a 33~ 00/16-
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
M
Lot No.
Block No.
l
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 Windows/Doors Pond
_ Electric _ Plumbing — Sprinklers
_ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Narne_Li. �f� .to 0
Name:
Address: — ap toou-J
Company:
City: + fit. hc�tL�cs State: 7/
s
Address: <e
Zip Code: 199 C. Fax:
City: State:/
Phone No. VjP fJ - Y,77 rig (p (� E-
zip Code: �f y Fax:
Mail:
Phone No =_ -
Fill in fee simple Title Holder on next page (if different
E-Mail t
from the Owner listed above)
State or County License C =
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 MORTGAGE COMPANY: Name: Not Applicable
Address: Name:
City: Address:
State: City. State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — Not Applicable
Address: Name:
City: Address:
Zip: one: 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 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.
Ph
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 OWNE . our faiilure 'Record a Notice of Commencement may result in paying twice for
improvements to operty. Notice of Commencement must be recorded in the public records of St.
Lucie County and posted o e jo site before the first inspection. If you intend to obtain financing, consult
with lender or an attorne befo ommencin work or recording your Notice of Commencement.
of Owner/ 1'eslsee/Contract r as Agent for
ATE OF FLORIDA
)LINTY OF
Sw to (or affirmed} 6d subscribed bef me of Physical Presence or Online Notarization
this eZ�20_,aL b
C)Z5-
Name of person making statement.
Personally Known '�: OR Produced Identification
Type of ld �tific 'on Produced
re
of
Commission No. c?V1 (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
[SATE
COMPLETED
r Notary A Ha Staff of C toride
Lynda A Hadley
t�iy Commisa w GGs 284432
or E*r" i2/1gr2o22
SUPERVISOR I PLANS � VEGETATION 1 I SEATREV R LE I MREV EWVE
REVIEW REVIEW REVIEW