HomeMy WebLinkAboutBuilding Permit Application 1 f
All APPLICWT INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:4
Ir.
O
p Buildin Permit A lication
g pp
Planning and Development Services /
Building and Code Regulation Division Commercial Residential 1/
2300-Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
I
PERMIT APPLICATIONI:FOR:
4
rPRQ.POSED IMPROWffVIfENT`LOCAT(t?N
Address:
Pro perry Tax ID#: e� 0 Q `�_ Lot No.
Site Plan Name: Block No.
Project Name:
DETA{LEQ DESCRfPTlON`�O`F IN�JR{�� �� y -� �c t <�r ;
I
New Electrical Meter i Second Electrical Meter (Affidavit required)
I
CO'N1�TRl�CT1C�N 1'NFOR�MATION ��a � Y
4
I
Additional work to be performed under this permit—check all that apply:
_Me anical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond p
Electric Plumbing
_Sprinklers _Generator .Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
CoIst of Construction:$ 6?0,
U�� Utilities: Sewer _Septic Building Height:
� — 1
v
Name //J Name: ez
Address:Lg2 /� �_ ca Company. r i
City: f Stater Address:
j
Zip Code: Fax: City: State:
Phone.No. 7�v�— v��T- �� �[� E- Zip Code: f�_ Fax:
Mail: Phone No l.—G
Fill in fee:simple Title Holderion next page(if different E-Mail
from the Owner-listed above) State or County License z O .
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. j
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
I
i
SUPPLEMENTAL CONSTRUCTION LIEN LAUV IN-FORMATION N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name. Name:
I
Address: Address:
City: State: City: State: I
Zip: Phone Zip: Phone: I
I
I I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: i Zip: Phone:
i
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.
I
St.Lucie County makes.no representation that is ranting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Associationrules,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.
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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing,consult
with lender or an attornev before commencing work or recording our Notice of Commencement.
I
Sigffature of Contractor-or-Owner B ilder as applicable
STATE OF FLORIDA `
COUNTY OF
Sworn to(or affir )and subscribed before me of ✓ Physical Presence or Online Notarization
this / day of 200 by
Name of person making statement.
Pelrsonally Known OR Prod u ed Identification
Type of Id fication roduced .
I � �
(Sig ature of Nota�=Veo
- tate of Florida)
i J.Pr e
Commission d° eaI)
STATE OF FLORIDA
I
Comm*GG262780
E ires 9/26/2022
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
i
- i I
II