HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /s2 PeZ Permit Number:
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 rOR: EMie12(setNcy A/C C'�Aj�,s(se DuT- ti:tcE
PROPOSED IMPROVEMENT LOCATION:
Address: I SOH), AGUELA k\(G
Property Tax ID ff:
Site Plan Name
Project Name:
DETAILED DESCRIPTION OF WORK:
N
N
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No.
Additional work to be performed under this permit - check all that apply:
)(Mechanical _ Gas Tank —Gas Piping _ Shutters -Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
sr pro
Cost of Construction: $ ry� r�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
lit
OWNER/LESSEE:
CONTRACTOR:
Name
E
Name: MkRIC A
V:ENJES
Address: I SbL10% A�rt—A LA AMC-
Company: ZTr L,TNC.
City: -OL F-Vgaac.6 State: -rL.
Zip Code: qq,,,,� 4Fax: r�
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Phone No. �� d1lt � p �� 7 E-
Addres :
r L-LT' 12 �(-_
City:
Zip Code: 3c'i a(ce:!
Phone No l
Stat e:
fax:
0
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �PrC m lZ
t
I AC . Cowl
State or County License
♦; b `{ S A53
If value of construction is 2500 or more, a RtLUHUtU rvouce or l ommencement n leyunnu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
77
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 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 t jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording vour Nntirp of rnmmpnrpmpnt
O�UAAV��
Signature of Contr ctor- or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn ,.foryaffir ed) and subscribed before of V Physical Presence orOnlineNotarization
�e
this �� a of ECE 2 b
Name of person making stat ent.
Personally Kn wn OR Produ d Identification
Type of Ide ication Produce
(Signature of Notary Public- State of Flo a)
Commission No. W
(Seal)Moto:y PAII, s'�a�e or rionaa
5 ssan 335912
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