HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L,uc_�vL
Ir " >= �` "� 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: (eco (�w,\a uce
J
PROPOSED IMPROVEMENT LOCATION:
Address: Ali ?Wnl
Property Tax ID #: 5 '" r Lot No.
Site Plan Name: Block No.
Project Name: -
DETAILED DESCRIPTION OF WORK:
L Y-e
New Electrical Meter Second Electrical Meter (Affidavit required)
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: wb • Sq. Ft. of First Floor:
l`A ► / 1
Cost of Construction: $ 0� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name GAG-
Name:
Addre
Company: t cey"
City: State:
Zip Code: �LmFax:
Phone No.2-L5L, ��� E-
Mail. 1 ()Q.'1lAgY=C-\1_.i dlz AN_
Address: tier
City: � Y-% _ State: C—L
Zip Code: _(F�ax:I�^� 1!��
Phone Nn_rn.. ?)' �'1� q I �LXI, 1(
Fill in fee simple Title Holder on next page (if different
E-Mail l�.} CrVfOI
State or County License SCE D_q Ucy n 4
from the Owner listed above)
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: _
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 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.
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 aPmQ.ey before commencing work or recording our Notice of Commencement.
Sign Lure o ont a r - orne'rTuilder as applicable
STATE OF FLORIDA
COUNTY 0F_�-}-r1Y'1
Sworn to (or affirmed and subscribed before me of Physical Presence or Online Notarization
this -20 day of ffba by
Name of person ring statement,
Personally Known X OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- Stale of Flo
Commission No. "IS33WD(Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev 1071TI:71
ZONING
REVIEW
Notary Puhlts State of Florida
Ciara Marie Heveron
1il M HH7 930 0ton
�xp. 101712425
SUPERVISOR PLANS I VEGETATION ' SEATURTLE I MANGROVE
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