HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLI AMON TO BE ACCEPTED
Date: Permit Number:
LL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ESL;A; C( a �t 1/�'#rd.. PC 5
Property Tax ID#: s l(,)0/ ! Lot 110.
Site Plan Name: Block No.
Project Name:
I1wTA11_ED DESCRIPTION OF WORK:
�" 1 1 C G - j 4
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: Sq. Ft.of First Floor:
Cost of Construction:$ ( Utilities: _Sewer _Septic Building Height:
O'JVNER/L SSEE: CONTRACTOR:
n Na sZ ;
na "YYt -I' �C� ' Name:_ �: o,n S'7�.)
Address: 3i S-b jU i- �di (.t;G Company: ll ' t, 6c;-A fP uq-�---
r,
city:_ �ty-h CA I,,� State: Address: L 5 i�7- Ste...
Zip Code: �J`I lc Fax: City:..Vd�-E 's�4 WC, State: -I
Phone No. Zip Code: ,-;CH Fax:
E-Mail: Phone No-?-??-- 22i9
Fill in fee simple Title Holder on next page(if different E-Mail ScL�t:� ,-x 6D,r ign xA yyry Y) a 0 r,-
from the Owner listed above) State or County license
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 L AW INFORMATION-.
;DESIGNS ENGINEEa: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: C t� )- - Name:
Address: Address:
City: 5-ruy� State: City: State:
Zip: Phone 9\lri-Lfg'—� 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 1 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 rd a Notice of Commencement may result in paying twice for
improvements to your propertyf otice of Commencement must be recorded in the public records of St.
Lucie County and post d o obsite before the first inspection. If you intend to obtain financing,consult
with lender or an r ore commencin work or recordingour Notice of Commencement.
Signature / /Contractor as Agent for Owner
ST OF FL D
C UNTY OF
Sworn to(or affirmed)and subscribed before me of deal Presence or Online Notarization
this Z7, day of L-jt�( n':as 20 j by ` '0}-l- S, S7'-t
Name of person making statement
Personally Known OR Produces a ification
Type of Identification Produced_ _ _`._
(Signature:of Notary Public-State of Florida)
Commission No.l Z 2-H (Seal) _"°% xri sE vrRn
_• :a-
Notary aubk-State of Fonda
Commission;HH 754s2
MY Comm.Expires Dec 29,2024
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