HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S �`I: U LUG`..', E R
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: I `ll,�
Property Tax ID #:
Site Plan Name:
Project Name: I
New Electrical Meter
Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Lot No. `7 2-
Block No.
Windows/Doors _ Pond
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ '1�k Utilities: —Sewer —Septic
Roof Pitch
Building Height:
Name L" 0..C\ Name:
Address: 1� t �l ' Company:��, Jae t,�-� (a ;nC� l
City: P, State: �-' L Address: '2S6$l
Zip Code:`3tlO\ (o Fax: City: State: L
Phone No. 1 J 5 73 -- (0` L0 ,� E- Zip Code: _Y3 Fax:
Mail: Phone No ��`i �oL)o (fo-6
Fill in fee simple Title Holder on next page (if different E-Mail XIA 1 Cgrl�A p LCh 4� 51-r- 11 c . CZ>1-
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.
SGPpLENh�M11TAil`=`C,f NST'RUCTI"ON LIEN LAW INF`bkMATION
r
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 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 ures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNI G T OWNER:;ur failure to Record a Notice of Commencement may result in paying twice for
im rove ents toy'prust be recorded in the public records of St.
L ieComy d edn. If you intend to obtain financing, consult
Ith lener a tneV 6tifnre commencing work nr racnrrlina vnur Nntira of f nmmAnrPmont
Si of a Lessee/Contractor as Agent for Owner
ST E OFF ORID
C NTYOF 5
Sworn to (or affirmed) and s scribed before me of Q�,,,Physical Presence or Online Notarization
this _3- day of dJL7�1 �a+.� 20�i by
\
Name of person maki g statement.
Perso Ily nown K OR Produced dent' ,cation
Type fide tification roduced
(Sign ure cf Notary Public- S te of Florida)
DULCEMARTINEZ
Commission No, (Seal) �o<r�`Y,PUB".c
Commission # HH 119702
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Expires May 10, 2025
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