HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
s 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:
Address: Ia-1 MI '*V�� s�m`}
�`
Property Tax ID #: L.�' O�• �' oh-"-' W'3. Lot No.
Site Plan Name:
Project Name:
[DETAILED DESCRIPTION OF WORK:
le to Metal with
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank — Gas Piping ^ Shutters
(Affidavit required)
Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 5000
Cost of Construction: $ 47,700.00
EE:
Sq. Ft. of First Floor:
Block No.
Windows/Doors ___- Pond
Roof 6/12 Pitch
Utilities: —Sewer _Septic
Name
Addr 1 s:
City: State:
Zip Code: Fax:
Phone No. E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height: 11 ft
Name: r
Company:
Addr s: ��
City: tate:
Zip Code:3�Hlb Fax:
Phone No 5 (D ' q3 G 9
E-Mail_Ff' t rn k O FZ C. Corn ,
State or County License 1254-1211 I -154 2__
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
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 Cou*tedments.
The following building permit applications are exempt from undergoing a full coview: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and -a to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Comme�nc' esult in paying twice for
improvements to yo prope y. A Notice of Commepe red in the public records of St.
Lucie County and ted a jobsite before the- first f e u d to obtain financing, consult
with lende or attor re commencingwork ai cor ' ice of Commencement.
Signa a of O r/ "—ssk7tontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Martin
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this 2nday of December, 2o21 by
Christopher Bates
Name of person making statement.
&Amu W COMZAM
Personally Known X OR Produced identification ; Maury Public 5a.edfk+rfd+
Type of Identification Produced my, Cww. wwK Aw s 2022
(Signature of Notar Publ Stat f Florida)
Commission No. GG197318 (Seal)
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