HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a -05N
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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:
PROPOS�O iPROVI=M, IT LUCIT1UNf
Address: —70 p 1 �otf e-J 1'il1e5 bf oAe
Property Tax ID#: 33 2-2-504 —061 9 -60"1 Lot No.
Site Plan Name: Block No.
Project Name:
E A( E T �OFVI (01LD 0RCf,
AL (1k Age 6
New Electrical Meter Second Electrical Meter (Affidavit required)
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Additiopal work to be performed under this permit—check all that 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:
R.oIIERjLSI
Name ! rpy G� Name: Co /'1�
Address: �c�RN To/rG 1 Pioes Cr Company: T05`I l hl j' i
City: uce JJ^^ State: Address: %�/� �54) Si<-?O �4�2
Zip Code: 31 gb Fax: J-W City:AA ". 4- L-vc)G State:r4C-
Phone No. E- Zip Code: 3/ 15 3 Fax:
Mail: Phone No 7:Z Z. -3 23 _3)0 7,Y
Fill in fee simple Title Holder on next page(if different E-Mail 'Sc�S�(�1."<f l dc1�Jon K^ 'A
from the Owner listed above) State or County License_
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.
SUPPLEMENTAUCONSTRUCTION..I.i N I.AW 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 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 Coun -and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leptrer or an attorney before commencing work or recording our Notice of Commencement.
ignature of Contractor-or-Owner Builder as applicable-----
STATE OF FLORIDA
COUNTY OF ZA
Sworn to(or affirgid)and subscribed before me of Physical Presence or Online Notarization
thisc)w'-day of A_,lsae. 20QLAby
Name of person maki g statement.
Person nown N OR Produced Identification
Type o Ide tification Produced
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( ignatur of otary Public-State of Floridfl LASHAMNAINGRAM-RAMMING
MY COMMISSION#GO 275060
Commission No. (Seal) gj p EXpRMDmmbet20,20222
oF�;;$••'� Bor4WIlNUNotefliPUb6CUedCM'dtor6
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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