HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: ` ��n �` amp
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Address:
Property Tax ID #: - 00 ? - 000 5-000 Lot No. _:0-_
Site Plan Name: Block No.
Project Name:
----
1 � [ CRIQT GN OF WORK:
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New Electrical Meter Second Electrical Meter
:�,, NSTRUCTION INFORMATION:
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Addit' nal work to be performed under this permit - check all that apply:
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_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors —
Electric _ Plumbing _ Sprinklers _ Generator Roof _ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 5, o g1, Utilities: —Sewer Septic Building Height:
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Name d Name: lo �rVs 3
Address: 0 'e Company
city LOJI, State: Address:
Zip Code: 3 Fax:'7�7� 3%gj�'7Zr% City: e:
Phone No.—? -7 0- —3 q— q'? Zip Code: FFaax-772-A398-9 ?2
E-Mail: r4w0gQIft, r) at 02 r10=4.0ef Phone No ^7?�L-�%� "7�Z 7 _ 77
Fill in fe simple Title Holder on next page ( if different E-Mail haC C�1�r,
from the Owner listed above) State or ounty License / iq C 0� 2?)
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.
N 09" x
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: Not Applicable
_
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 anlattorney before commencing work or recording our Notice of Commencement.
:
Sig,' f Owrk!,r Lessee/Contractor as Agent for Owner
nature ,'Contractor/License Holder
STATE OF FLORIDAl'�
Q,
STATE OF FLORIDA,J"_�
COUNTY OF
COUNTY OF Gi,C%�
,(xrC/e--
Swor o (or affirmed) and subscribed before me of
Sworp to (or affirmed) and subscribed before me of
✓Physical
Physical Presence or Online Notarization
Presence or Online Notarization
this 2D day of C.P�YI( 202{ by
this_ day of t ✓ 20) 1 by
Name of person making/statement.
Name of person making statement.
-"/
Personally Known N OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
( Produced
(Signature of Notary Publi
(Signature of Notary Publi
Notary Pubuc State of Florida
Craig A,Grossman
�y� * Notary Public State of Florida
Commission No. My �suon GG 983089
E�a��es 05 �01202e
Cra��p ossman
ommission No. My Cii@miision GG WN69
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c� n�
ExDires05/1012024
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