HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SO
T L' OME
oomP & Building Permit Application
Planning and Development Services f
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone. (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR: V�bk{
PROPOSED IMPROVEMENT LOCATION:
Address: J �S i }
Property Tax ID #: - - Lot No.
Site Plan Name: k&Xjw-_rA Pat'f-- Block No.
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 _ Gas Tank — Gas Piping , Shutters _ Windows/Doors Pond
_ Electric X Plumbing —Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ . 0
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: _Sewer —Septic Building Height:
Name Y1 T i
Address: `
City. r� �f� State: rL
Zip Code: Q Fax:
Phone No. ql - Y1
E-Mail:S ck4t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR_ :
Name: U
Company:_ ►t vliv� L�V1 W(4`Vi
Address: iJ5 &� 2LTC. V a r K Lad&, ___
y: ���
City: � J i.l,l.�� State:_L_,__�-
Zip Code: Mg_ �7_ _ Fax. ! aZ "wI—que9
Phone No - (-
E-Mail ocic�
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phon
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State.
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: `/4Not Applicable j
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-
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
structure. conflict
consult any applicable
Home OwnOwners
rs A sociation andrreview your deed for covenants
restrictions which may applyhibit such
In consideration of the granting of this requested permit, I do hereby agree that l 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 attorne before commencin work or recording our Notice of Commencement._7so�� V Al��d�w I X —I%eY 0-1 IZ—
Signature of Owner/ Lessee/Contractor as Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA ; , STATE OF FLORIDA ,
COUNTY OF Lu COUNTY OF 5
i
1� Not Appli
State:
Swoyn to (or affirmed) and subscribed before me of
,/ PtAysical Presence or Online Notarization
this day of -- C�--f-v -' f , 2021 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced L
ti Y JULIE JANE MCCAULEY
'$ Notary Public State of Flom
Commiss HH 49124
"Ay Comm. Expires Oct f, 2424
REVIEWS FRONT ZONING
I COUNTER I REVIEW
Swor�r'fo (or affirmed) and subscribed before me of
PIysical Presence or Online Notarization
this -) day of �� Y 2020 by
M t> /6 k,
Name of person making statement.
Personally Knowny/ OR Produced Identification
Type of Identification
Produced
(5ignapu ot�r,r.��nuC-�tate.ortisit��
JULIE JANE MCCAULEY
`- Notary Public . State of Florid;
Comml$S i sr m rIH 49824
M Comm. Expires Oct 1, 2024
Y p ary i�ssn
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