HomeMy WebLinkAboutBUILDING PERMIT APPLA(I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
21T. LL c11L
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:
PROPOSED IMPROVEMENT LOCATION: n
Address:5�)e
Property Tax ID #: 1 J Ls' Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all tat 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:
OW NERAESSEE: f,�—
CONTRACTOR:
Name Iu r
Name:
Address: o :-� �or-�
Company: , `f -- C o I ? " `'t�
City: rc-<'-� State: �%
Aril dress: a Z( 5Z
Zip Code: 5 5Fax:
City: ���� �' State:
Phone No. .77a _ / " Uf .0 E-
Zi� Code: �Cl� 9 1Fax:
Phone No
ElMail < A-O ACC tE�QAJ C A-'S—A" 00K-L'
Mail: ,- w 4 i 75'� v d v
Fill in fee simple Title Holder on next page (if different
Sate
or County License Ctls'c -
from the Owner listed above)
if value of construction is 2500 or more, a KtCUKUtU Notice Oi l°OmmenGCmtlnL lb i cquu cu. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
City:
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv'�:
Zip:' Phone:
BONDING COMPANY:
Name:
Address:
Citv
Zip:I Phone:
Not Applicable
State:
Not Applicable
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 S�. 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 lanrlpr nr nn gttnrnpv hpfnrp cnmmencine work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
k u c' c C
COUNTY OF • rocs
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 'ZXD day of 1X_C. 20—Z-1 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
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Commission No. (
Jf 1NICE GERROW
MYCOMM140SION#GG269744
Bonded
EXPIRES: September 18 2022
Ttu Notary Pubk W&ffli%i n
l
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Rev 10/12/21