HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
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I? Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ` a
Lot No.
Property Tax ID #: L "
Tno p-?9-0 Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter _Second Electrical Meter
CONSTRUCTION INFORMATION:
� — L;
Additional work to be performed under this permit— check all that apply:
_Mechanical — Gas Tank Gas Piping Shutters
Electric V Plumbing _ Sprinklers , Generator
Total Sq. Ft of Construction:
Cost of Construction: $ F
OWNER/LESSEE:
Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name L.\
Address:Az a La!2r 1 1yZ
City: « State: FC.-
Zip Code: ll�i Fax*.77a-SS71-L,
Phone No,
E-Mail,
Fill in fee simple Title Holder on next page (if different
from the Owner lasted above)
CONTRACTOR:
Name:
Company:
City. _ �L State:
Zip Code: Fax: 13% 51i- 01O5
Phone No
E-Mail
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: 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
4—
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
or such
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict prohibit
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 5t. 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 attorney before commencing work or recording our Notice of Commencement.
Signature of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
S Lu
COUNTY OF� u
Sworn to (or affirmed) and subscribed before me of V Physical Presence or online Notarization
this 2 day of "rK __ 202t by
Akx hyiP
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced ,12� Y)Sg-
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(si a a r y yy 4 1'5 flori j
= Notary Public • state of Florida
Cory S Commission K HH y y
WPPa
y comm.t�`�i``
landed through National Notary Assr.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
.
DATE ------ _ _
RECEIVED
DATE
COMPLETED
_.
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