HomeMy WebLinkAboutBUILDING PERMIT PPLICATION UPDATEAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
gj L QC�
O
�? Building Permit Application
Planning and Development Services
Building and Code Regulation Division Cammercia[ Residential
2300 Virginia Avenue, Fort Pierce -FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
y-I,b - 10% - b ` v
Lot No.—
Block'No.
coo i�iLK - Tvc�ris11 �G,�.4 - H>Awta D40..LA/ A. r.).aV . r►S C+U-G-•�
s'v.•r.b� 206�
New Electrical Meter Second Electrical Meter (Affidavit required) ;
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 -"oof - Pitch
Total Sq: R of.Construction:: ��� Sq: Ft.'of First Floor:
Cost c f,Construction: $ VQ 61 CV Utilities: —Sewer -Septic Building Height:. iS09,
Name J r-J UcwbAC
Address: 7-L n (� e' c R JS \A 1 CQ-
City: 44 SC State: V
zip Code: 1ASO Fax:
Phone No. '117 �� • 1 IT E-
Mail:��) A,-XSQQAV&I 0 lx-q. -ri -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: ox\Atvc,-i dE�N� 2o�i�
Address- ex
City: r ve-t State: -�PrG-
Zip Code. fS Fax;'
Phone No �'1Z 2Y� 5L4
E-Mail 4VA'1P F-0&844JJ&0F • C0" 1
16
State or County License l�� $�
IIf 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: _ Nat Applicable
i
EName:
MORTGAGE COMPANY:
Name:
Not Applicable
iAddress:.
Address:
I
City: Stater
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
If 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.
to 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.
I _
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.
i Lucie County and posted on thejobsite before the first inspection. If you intend to obtain financing, consult
I with lender or an attorneu before commencine work or recordine your Notice of Commencement.
Signature of Contractor - or - OwnerDtkder as appitc le
STATE OF FLORIQA,
COUNTY OF-.
Sworn to (or affirmed) and subscribed before me of -,/
Physical Presence
or Online Notarization
this Z_ day of b, 'ty M &_Y- 20Z by
Name of person making statement.
I
/
i
Personally Known' OR Produced Identification .l
Type Identification Produced . V I
(Si tore of Notary Public -State of Florida)
H Seal
Commission No. }
Y Pu NIE EZ
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to of
Notary Public -State of Florida
Public
Commission # HH 165955
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My Comm. Expires Aug 17, 2025
Bonded through National Notary Assn.
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