HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:y a - 0 ut ' at Permit Number:
000
11 a 00 1� o D r,� - = 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #: 1
Site Plan Name: i+
Project Name:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
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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 _ Plumbing rl _ Sprinklers
Total Sq. Ft of Construction: d•�
Cost of Construction: $ 5 �� U
OWNERAFSSEE:
Name
_ Generator _ Roof Pitch
Sq. Ft. of First Floor: J
tilities: ) ,Sewer _Septic
Address:
City:Y� State: f�L
Zip Code: 1' 0VV—L Fax:
Phone No.
Fill in fee slm le Title HolderIn next age i differeilt�m
P P
from the Owner listed above)
CONTRACTOR:
Building Height: �;t
Name: AOM sftaw
Company: c
Address: t1 Q1��L��Q � O
City: V Stater
Zip Code: _a-�O Fax: l
Phone No_ "1u1_'_ 'M�
1. Mail. n_C�C
StdW or Crrunty I iL(C rise_LK a� 3tz q�—__
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
Name: i2 'I S
Address: '1
City: State: U
Zip: Phone LJOI • o'L
MORTGAGE COMPANY: _XNot Applicable
Name:
Address:
City: State:
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 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
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Pr ce or Online Notarization
this t! day of Ben2021 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced A U, . 0
Signature of CodtTVctor/ricense
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed befo a me of
Physical Presence 011 Online Notarization
this I day of4t202 by
Name of person making statement.
Personally Known _X, OR Produced Identification
Type of Identification
(Signature of Notary Puovvel
�Igmagerge (Signature of Notary Pu tate� i assiay tserger
OTARY PUBLI �� OTARY PUBLIC
Commission No.TATgn8IJLORI A Commission No. TE OF FLORIC
yomm# GG973629 Comm# GG973629
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAl10N SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW IZEVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED