HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �y �� �� e ( Z� h zo 2 Permit Number:
r 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: c_4 f
Property Tax ID#: (�c7 -be 73 - 0OO - ,<� Lot No.
Site Plan Name:
Project Name -
Block No.
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: $
OWNERAESSEE:
_ Gas Piping
T Sprinklers
/:
(Affidavit required)
_ 5hutters Windows/Doors Pond
Generator _ Roof Pitch
Sq- Ft. of First Floor:
Utilities: — Sewer — Septic Building Height:
Address: (90 5 E Faxs, Y S+
City: c,C4 f�, ecce State: EL -
Zip Code: '3u � 22_ Fax:
Phone No. _�72 - 6 i - 5�? c E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: t %
Company: i3C i �t`t P_ .
Address: _t rir a. fe
0ty:_fbr_Tf State:
Zip Code: 3 Fax:
Phone No 7 7,:P- cZ-6 ✓c�
E-Mail,'2i5t�_,
State or' County License
If value of construction is 25W 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:
— Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before crimmAnrina Wnrle nr _r __
- - - -- —1-5aanJvul IVUULU U1 Commencement.
Signat f
4r4_,eXrIL4elContractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF LIt
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day
of_ CV('MhCc" 2021 by
rya r V IAI Z le
Name of p4 rson making statement.
'/
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Pualc- State of Florida)
coun
Commission No. {T�l,j �� =+r *s Comm.$GG36 658
(Seal) Expires• Augf d 25,20
4'- a
Bonded TW Am Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5120121