HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
Building Permit Application
Plonning ond Development Services
Building ond Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (7721 462-1553 Fax: (7721 462-L578
Commercial Residential
CBDG Funding
PERMIT APPLI.ATIoN FoR: ,41*, o 6uzqttr-r- (nautlea
PROPOSED IM PROVEM ENT LOCATION :
Address:?(q + F,'L leno ar I /avt .*" lua,'- . F<- 39g,2
Property Tax lD #:
Site Plan Name:
Lot No
Block No.
Project Name:n6/
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION I N FORMATION :
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Generator _ Roof _ Pitchg(tlectric
-
Plumbing _ Sprinklers
Total Sq. Ft of Construction:Sq. Ft. of First rloor, /& fd
costofconstructionrs J000,a Utilities:
-sewer -septic BuildingHeight:
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
lf value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DETAILED DESCRIPTION OF WORK:
OWNER/LESSEE:CONTRACTOR:
Name
PhoneNo.-QiO-*2o- 836C E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:5mlj/- ,-7*t - Lourl
Company:
City:State:FL
Zip Code:
Phone No
3i
E-Mail
SUPPLEM ENTAL CONSTRUCTION LI EN tAW I N FORMATION :
Name:
Address:
City:State:
Zip: _ Phone
MORTGAGE COMPANY:_ Not Appllcable
Name:
Address:
City:
Zip: _ Phone:
FEE SIMPTE TITIE HOLDER:_ Not Applicable
Name:
Address:
City:
Zip:
-
Phone:
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Apptication is hereby made to obtatn a permit to do the work and installation as indicated.
I certlfy that no work or installation has commenced prior to the issuance of a permit.
St. Lucle Countv makes no reDresentation that is lrantine a oermit will authorize the permit holder to build the sublect structure
whlch confficts with anv aoolicable Homeownersassocialioh rules. bvlaws or and coVenants that mav restrict or pr-ohibit such
structure. Please consult rirrith your Homeowners Association and ieview your deed for any restrictions which maV apply.
ln consideration ofthe granting ofthis requested permit, I do hereby agree that I wlll, in all respects, perform the work
ln accordance with the approved plans, the Florida Bullding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoirrg 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 fallure to Record a Notice of Commencement may result in paying twice for
improvements to your propertv. A Notice of Commencement must be iecorded in the public records of St.
Luiie.County and fosteil on thri lobsite before the first inspection. lf you,intend to obtain financing, consult
with lender br an bttornev befor-e commencins work or retordinp vour Notice of
- or - Owner Builder as applicable
SwornJo {or affirmed) and subscribed before me ofthisX dayot Dcenlhtr .zo?!av
dphvsical Presence or online Notarizatlon
-Lor-i s
Name ol person statement.
Personally Known
fifr
Notary Publc Slaa ot Flonda
Takeemah Wan6n
My Comrn3stm HH 008890
Exprros 06/10r202{
OR Produced ldentification
Type of
Commission No.(Seal) ',
a
FRONT
COUNTER
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