HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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> _ 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: i H a ISLuf s) '-ir 20ft S1 I c 1() f . EL 19 LS
Property Tax ID #: SylCI- sc)0 - nl0-n-()0C) = Lot No. (_D
Site Plan Name: Block No. % I
Project Name: A(jhfwr) Pyn1 knc
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ S.SOO
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Wif,
Name: "a Bb m(y
Address: lL]c�
_ _
Company: ?Auwr E1PrAY&'
City: P0a<W. L"(.I State: ('L-
Zip Code: �LBK3 Fax: --
Phone No. ffp E-
Address: L 60X 13 5
City: oa a L. a(At State:
Zip Code: MR'S Fax:
Phone No -rya- S3J -()()55
Mail: ��C �oI\P,l� o QLY—oj Cocy:)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C
_
State or County License ECI 1 -
Vtl4C u! LuMLrucuon is zauu or more, a KLILUKutu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF S; - LLICUL
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this � day of �PC1?�(Y116et" 20a1 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Idenjification Produce j
(Signature of Notary Public- State of Florida )
Commission No.66gl00t-13 (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
ALISON HANSON
MY COMMISSION k GG 970043
";r off= EXPIRES: March 16, 2024
Bonded Thru Notary Public Undenwrlters
SUPERVISOR PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW