HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IL,3
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia A ven ue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
L
IT APPLICATION FOR:
OSED IMPROVEMENT LOCATION:
Address: J
Property Tax lD #: q l g442
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
_ Gas Piping
_ Sprinklers
(Affidavit required)
Shutters
— Generator
Sq. Ft. of First Floor:
Windows/Doors
Lot No.
Block No.
Pond
— Roof Pitch
Utilities: —Sewer —Septic
Name
Address: 1 a r4
City: �Itat State: -'r/
Zip Code:.3 4 9,6 9 Fax:
Phone No. r% - zj ee ICE -
SF E
Mail: 7 c� Qak . Co, -n
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: �o ei9 N
Company: S
Address: 43 S<U 3;♦ - sr
City: v State: -Z/
Zip Code: _ 3 ygg3_ Fax:
Phone No. r%7a - 82 9-/4//y
E-Mail
State or County License Cl--:-
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:
Zip: Phone City: State:
Zip:� Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable FAddress:
COMPANY:
Name: , Not Applicable
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 toy 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 bed on the jo site before the first inspection. If you intend to obtain financing, consult
w'th lender or an atto befor commencin work or recordin our Notice of Commencement.
of Owner
.TE OF FLORIDA
)NTY OF
Sworn to {or affirmed) and
this AQJ day of /Y�
Name of person making statement.
as AgeX for Owner
before me of
20,,2L by
Personally Known x OR Produced Identification
Type of I d . enlication Produced
Public- State of
Commission No. 0'?84; (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLET
Physical Presence or Online Notarization
ZONING I SUPERVISOR I PLANS
REVIEW REVIEW REVIEW
R
LYMda Notary A t)llcHa State of Florida
Lynda A Hadley
MY sion GG 284432
EYRkes Uf181 =
VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW