HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ a Vsk;
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
>� LUCEiL
`r Building pp 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
PERMIT APPLICATION FOR: --��ti � r a
PROPOSED IMPROVEMENT LOCATION:
Address: (�' r �'�-� (i n.,z p k,y
Property Tax ID #: 4
Lot No. ,.,
Site Plan Name: 4LA:&LIy ,�� `L?-` 1 Block No.
Project Name: ✓�vy
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
_ Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name K
Name:
Address: ' ,r. (," 1 y t -.��
a
Company: v � Vic: � .��'t,. : ck �_
a
City: {�,� r'r� & /� State: ✓
Address: j 5� v
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Zip Code: V:N [� Fax:
City: Stater
Phone No.:.,� `f 4�_ Gfl -
Zip Code: ��' j � Fax:
E-Mail: �.�'ii1G4�� ��� �, c, r` c�+�
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Phone No �C �_ ��' 7 7 ` �C SAL-)
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Fill in fee sirrifple Title Holder on next page ( if different
E-Mail 01 14
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.
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 beforefte first inspection. If you intend to obtain financing, consult
with len er or an attorney before commencingwork or recording our Notice of Commencement.
Si ture of wner essee/C tr t as Agent for wrier
STATE OF FLORIDA ��
COUNTY OF `� ,
Sworn to (or affirm and subscribed fore me of Physical Presence or Online Notarization
this. day of 20�2L by r-
Name of person making statement.
Personally Known ' \ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
PAMELA A. KEPHART
o�pRY�ss
`1 '� o NOTARY PUBLIC
Commission No. - � 'a �- (Seal)
L ?.STATE OF FLORIDA
Comm,# GG211428
.s�NCE I Expires 4/25/2022
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DATE
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Rev 5/20/21