HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: CV ILI
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'` a $• L �'B'uilding Permit Application
Planning and Developments rvices 9
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Address:
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Property Tax ID#: 14zz V- 00
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®co(q Lot No.
Site Plan Name: Block No.
Project Name: A
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping,.,. _Sliutters,- . Windows/Doors Pond
Electric `Plumbing Sprinklers _Generator _Roof Pitch
Total Sq. Ft of
Construction—Sq. Ft.ofsFi:rst Floor:
Cost of Construction:$ Soo Utilities: _Sewer____Septic Building;Height:
Name Name:
Address: 3 Snow G Company: (lLfA'I .
City: C�V�1 State:M
Zip Code 3/5 Fax: City:* J (� State:
Phone No. E- Zip Code:- F
Mail: Phone Z S
Fill in fee simple Title Holder on next page (if different " E-Mail V' 1 , _
from the Owner listed above) State or County License �C 5 0706
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.-
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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 Courfty 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 n.on-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 Cou ty d osted on the jobsite before-'the first inspection. If you intend to obtain financing, consult
with len r a attorne before commencing work or recording our Notice of Commencement.
Sign ure Owner/Lessee/Contractor as Agent for Owner
6
STATE OF FLORIDA
COUNTY OFC.{
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 2,�day of U-0, C_ 20-D�-\by
c CAV-,rl�
Name of person making statement.
Personally Known OR Produced I6' tific n
Type of Identification Produced
(Signature of 0-VRUGHN
OSPP :State of'Florida-Notary Public
Commission•N '2 ._ `m(gj�iulfi # GG•270079
My Commission Expires i
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REVIEWS FRONT ZONIN& %,SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW REVIEW
•DATE`,
RECEIVED ti
DATE `
COMPLETED
Rev 5/2-0/21