HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
LOCH'
Property Tax ID #: _
Site Plan Name.'.'
Project Name: DiSP4
Permit Number:
Building Permit Application
Residential
Commercial
CBDG Funding
FL. 3
Lot No.
Block No.
j DETAILED DESCRIPTION OF WORK: i
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical Ga Tank _Gas Piping _Shutters
_Electric lumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
/
Cost of Construction: $ `7, • co
Windows/Doors _Pond
Sq. Ft. of First Floor:,
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
1 Z
Name:
Address:4ta�O Sa311 c,410,A Ad'I�' W(" ISM
Company:
eEk
City �16NCerJ�Pa�I ` State: i
Zip Code: I fF,ax: I
Phone No. q — q l o E-
rr�
Address:155'7 JW Fe,#2 5! Df'. a.&+ UL
City: � I� ta e:
Zip Code: LN It 3 Fax:
Phone NoM -``u- 01—a�iZ
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mailii�. tkt e jam• 1141 a i I_ CCrI/s
State or County Licensee 1 ,f30a-q
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea. II
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
utbIUNtR/tNf2lNttR: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: _ City: State: _
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
_Not
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
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 attornev before rornmlPnrina minrk nr rnrnrriinu vn,ir runtiro of rnmmonromont
Signay a of Owner/ Lessee/Co ctor as Agent for Owner
STATE OF FLORIDA
�(
COUNTYOF /�"t 't ���vcrt
Sworn to (or affirmed and subscribed before me of p�Physical
Presence or Online Notarization
this kay of ayRti b4/20 24 by
7k(od4rt III
Name of person making statement.
Personally Known OR Produced Idelitification
Type of I e ' icatl Produ d
(Signatu706f Notary Public -State of Florida)
Dyian ehristopw Wear
Commission No. 33a SO (Seal) NOTARY PUBLIC
*-I
STATE OF FLORIDA
Comnf GG833282
Expires 1/6/2024
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