HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —) a1 Permit Number:
40 f JUL
Building Permit Application
Planning and Development Services St. LU010 only
Per I ng
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: t I�
PROPOSED IfVIPR01%EI.' ENT LOCATION s y
Address:
Property Tax ID #: �� `� a3— Lot No. A5'3p
Site Plan Name: 1 Block No. ��
Project Name: K t Cy
New Electrical Meter Second Electrical Meter (Affidavit required)
-
C.Q�NSTR�UCTION
Additional work to be performed
Mechanical Gas Tan
Electric Plumbing
under this permit — check all that apply:
k _ Gas Piping _ Shutters
Total Sq. Ft of Construction:
o�
Cost of Construction: $
Sprinklers _ Generator
Windows/Doors _ Pond
Sq. Ft. of First Floor:
Utilities: _Sewer �/ Septic
Roof Pitch
I Building Height:
OWNER%LESSEE
.CONTRACTOR
t`
Name CL U�l
Name:
elf
Address: D
Company:
`
City: State: _
Address: �
C
Zip Code: Fax:
City:
State —
Phone No.
Zip Code: �� i 3
i ax:
10
E-Mail:
Phone No — ^
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License 02 (0 Cb �
from the Owner listed above)
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.
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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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or ap attorne efore commencing work or recording our Notice of Commencement.
Signature o wner/ L see/ n ractor as Agent for Owner
STA OF FLORID c
COUNTY OF L�u,.C'� Ci
Sworn to (or affirm nd . ubscribed beme of Physical Presence or Online Notarization
for
this day of 20 by
\
Name of person making statement.
Personally Known OR Produced, Identification
T pe o dentificatlon Produced
(Signature of Nota ypublic- State of Florida )
Co j 0 Notary Public State at Florida eal)
Ifi�nISrOng
My Commission GG 913313
�1W Expires 09/16/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21