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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _1 Date: , � � r Permit Number:a aa31ll a. PL '=f 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: i PRO° ®S;ED IMPR USE,` ENT LOCATION. f % Address: � Property Tax ID#: �� \"i— 5 ,��5a����~ i Lot No. Site Plan Name: I Block No. I Project Name: 11 A® TAIi�ELED DESCRIPTI;QN OF WORK: i c II New Electrical Meter Second Electrical Meter (Affidavit required) C®'N�TRUCTIQN INIF®1RMATION: h 1 g k Addit'onal 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: _ Sq. Ft. of First Floor: Cost of Construction: $ Utilities: _Sewer _ISeptic B�i Icling Height: ©V1tI ffi/LESSEE COaNTfj CTOiR: % zV Name ., ` L Name: Addre s: Company: {- v �I, I City: State:_ Add r ss� � ZipCode: it � Fax: City: a � S11ta��te: Phone No : — r E- Zip Code: Fax:�`P-�1d''F�7 Mail: Phone N Fill in fee simple Title Holder on next page (if different E-Ma' i from the Owner listed above) tate or ounty 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. JI I SUP, LEM°ENTAL CONSTRUCTION LIEN LAW INI RIVIATION: �. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: it State: Zip: Phone Zip: I Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: it City: City: I� Zip: Phone: Zip: Phone: :I II OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wrk 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 t I 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,'j 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 anotHier 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 Coun n the jobsite before the first inspection. If,you intend to obtain financing, consult w' er or an attor before commencing work or recording our Notice ofil Commencement. i I Signature of Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF Sworn affirmed) and subscribed before me of �hysical Presence or Online Notarization this L—day of 20QAby T_'Wnr,AS Name of person making statement./ Personally Known " OR Produced Identification Type of Identification r duced I (Signature of Notary bli State of Florida) 00• Notary Pubk Stets of Fbrlda 49 Urania Ganes Commission No. (Seal) MyConwasshmHH 127153 or Expires 0508=25 it REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW (REVIEW REVIEW DATE RECEIVED DATE COMPLETED j ev i