HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: _
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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 \D e'-
Property Tax ID #:'�`1a\' �DL�'� I �'� \ _ Lot No.
Site Plan Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK:
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
Total Sq. Ft of Construction:
Cost of Construction: $ k V 00
_ Generator
_ Windows/Doors
Sq. Ft. of First Floor:
Roof
Utilities: —Sewer _Septic Building Height:
Pond
Pitch
OWNER/LESSEE:.:
CONTRACTOR:
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Name -Kn QT C3X
Name:
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Address:'-AaQ ( �i Q`
Company:
Address: (dan 1
City:-S`lState:N_
Zip Code: '�55 N"I ti Fax:
Phone No. E�V\ ���) "a���� E-
City:
Zip Code:
Phone No-N\ (V2r:5
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Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 1z�CS�N� sgc�O
State or County License'\0,1o�a\
If value of construction is 2500 or more, a RECORDED Notice or 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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
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 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 iobsite before the first inspection. If you intend to obtain financing, consult
...;.k ;e..ael.., �., �"+ r.,e„ kafnro rnmmonrina wnrk nr rernrdina vnur Notice of Commencement.
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Signature of wn a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OCct
Sworn to (or affirmed) and subscribed before me of X
Physical Presence or _Online Notarization
this±, day of l\f oyPvr 6,ev . 20 2A by
5+-
Name of person making statement.
Personally Known X OR Produced Identification
Typej` of Identification Pr d, uceed_
`State
(Signature of Notary Public of Florida)
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Commission No. H R 09 a5gq (Seal)
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Expires February 14, 2026
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