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 CBDG Funding
PERMIT APPLICATION FOR: 'A/ e M CJ
Address: q 4c,)� A-Z)LnCiC V)_�
Property Tax ID#: 13,5
Site Plan Name:
Project Name: �� w
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generators Roof (;Z Pitch
Total SFt of Construction: Ftof First Floor:q. q. _
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height: 9
Name Yl 1,
Name:
c�
Address:
City: Stater
Zip Code: C Gl Fax:
Company: , " I
Address: 2_ Q L 01 ky
12(
r
City: ^ 10,if l�l 1/(� State:
Phone No. E-
Zip Code: cbgg, j,5�, Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
State or County icense C
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.
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 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
improvg=nts to 4your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and poAtcl-an-thejobsite before the first inspection. If you intend to obtain financing, consult
with lender or an_attornev before commencing work or recording your Notice of Commencement.
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORI
COUNTY OF C_-
Sworn to (or affirmed) ands bscribed before me of
Physical Presence or Online Notarization
this-� day ofde p a u Q�W2e by
C�<
Name of p son aking�temer��_Personal[
nown roduced Identification
Type of Id tificatio Pro uced iI �
(Signature o ublic- State of Florida)
Commission No. (Seal)
t Kenny Henzow
Notary Public
3 State of Florida
y Comm# HH087667
s,
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