HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %� � 7 7'cV / Permit Number:
LUYC1L
(Cc `1
# It �VLI� 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
PERMIT APPLICATION FOR: Ele-ci (- C, C_
PROPOSED IMPROVEMENT LOCATION:
Address: 1('-i I �JrI -nn- `C _ A\GCS . 0/°)r-i-ate 1 e �i^`e D . 1�( -2i_. chC
Property Tax ID #:( JOcQ - Q aQ Lot No. �2
Site Plan Name: _FE) by-ze �S —CnyzA{-,rcp Block No.
Project Name: 0�-A6A-r
New Electrical Meter Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: p Sq. Ft. of First Floor:
Cost of Construction: $ i�, Ll78 k ��' Utilities: —Sewer
Windows/Doors Pond
Roof Pitch
_ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ur -
Name: cr1d G ills'
...
Address: 4J S , /JQr6tQ ICh. kqu
Company: 6114:r_ f
�1
�C' Q(-)d (4, r.
Cit Y, r+" : sA~ ( _q C` ,. State: r7
Zip Code: - "C Fax:
Phone No. 3 . C -
E-Mai1: o rr -eki oo G
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: 5
0_� '
City: 11( - Lf CY V
Zip Code:
Phone N -
State: E
Fax:
E-Mail
State or County License
""jo_' O �
VGUC uWIMFUcnuro is c:)uu or more, a Ktl.uKutU 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
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF FLO I A
COUNTY OF
Sworn to, (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this "day of_'k_J!L 1"nDAn9620 by
,I1L,�.�a:Wl
Name of person making statement
Pers OR Produced Identification
ype of Identification P oduced
(Signature of Notary Public- State of Florida )
YPii KONNI LENAE DEWITT
I� 'f'; Notary Public - State of Florida
Commission No. 1Oy-
(Seal) p`s Commission HH 165134
of F<-°`�'� My Comm. Expires Dec 10, 2025
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Bonded through National Notary Assn.
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