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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: - 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 CBDG Funding PERMIT APPLICATION FOR: PROPOSEpD� IMPROVEMENT LOCATION: Address: f g ( 5 �4 Virv, w *✓ Property Tax ID #: 3 O - 3 1 � - a O O - O © 0 - 7 Lot No. Site Plan Name: 1�c-C ),L; `3 Block No. Project Name: V': DETAILED DESCRIPTION OF WORK: Q es New Electrical Meter Second Electrical Meter (Affidavit required) I 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 _ Sprinklers _ Generator — Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 3 G. 4 Q • Q Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: Name 1,L;n-y Address: I 1 Cavt- City: �- 17 C eC'-G- State: Zip Code: -3 HIJ H S Fax: Phone No. (-7­ 1-1 +-L C1 — FL Mail: (moo. S`t 0 0 G I)e-t� 5111i ^ • ► -- Fill in fee simple Title Holder on next page (if different from the Owner listed above) Name: 1 ore-"tr. Lae- 4- L>G^s--' "Jtk,� Company: J s v-e"X--`''^ Address: 17 1- D Le ��V0-J City: (moo r� �< < u State: �- E- Zip Code: �LA S Fax: Phone No 77-1 E-Mail-��ASwT�LOr~S�-cj Gt�y^^ •1 •Gn/"► State or County LicensQQ 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. L L( SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable Name: _ Address: City: Zip: . Phone State: MORTGAGE COMPANY: _ Not Applicable Name: Address: _ _ City: State: Zip: _ - Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: . ; City: Phone: I 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consul 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. 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 lets or an attorney.3efore commencingwork or recording -your Notice of Commencement. Signature of Contractor - or - Owner Builder as applicable STATE OF FLORIDA COUNTY OF Sworn tclipir affirm ) and subscribed before me of +Physical Presence or Online Notarization this ay of A��.�►�-ram , 20 *7 by Name of person making statement. Personally Known OR Produced Identification Type of Idg hfication Produced _ (Signature of Notary Public- State of Florida) Commission No. G� �$ � 7� ea) +,,r Notury PutKic State of Florida Coen Sue Hayes + My Comounsiorl GG 287729 ran ExPirs6 oil IW2023 REVIEWS FRONT I ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED - - -- ev