HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: PermitNumber._
lr Building Permit Application
Planning and Development Services
Building and Code Regulation Division
.2300 Virginia Avenue, Fort Pierce -FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial• Residential
CBDG Funding
PERMIT APPLICATION FOR:
PR PO 4SED l-f7VtPR4,l/I . EN E.CiyCATIQN:
Address:/ �¢ ���� U"
Property Tax ID #: �` (� 0 D '�, C) _ Lot No.
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Site Plan Name: Block'No.
Project Name: Y oc)"E-
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New Electrical Meter
Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _ WindowsfDoors _ Pond
Electric _ Plumbing "Sprinklers _ Generator Roof �(ZaZ Pitch.
Total 'Sq.Fi-of Construction:: Sq: Ft.'of First Floor: -
Cost of,Construction: $ + �.�j�C� Utilities: —Sewer . Septic ' Building Height:.
b/L'ESSEE''
CONTR4CfOR.150
Name LJJVIbG e
Name:
Address: ` U22 �� ��,�� (-
Company:
City: >! t2fy State:3�:_l--
Address 1111 Sri
Zip Code: Fax:
city: PZ-r C,>T- LvL e State:Phone
No. 2'ZU 0 o 2�R E-
Zip Code: ` Fax:,
Mail: e ®�d�a�e��c®. a�+.�
Phone No ��J 2 4b2�i. 1 %,SU
E-Mail
Fill in fee simple Title Holder on next page (if different
State or County License LCC 133 f 02P
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of commencement is requireo.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION I L1EN IN. W INFORNIA�TION.
!DESIGNER/ENGINEER: _ Not Applicable
IName:
Mdress:.
MORTGAGE COMPANY: Not Applicable'
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
II 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 consu t 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,
I -
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
I with lender or an attornev before. commencing work or recordine vour Notice of Commencement- I
Signature of Contractor - or- Owner Builder as applicable
STATE OF FLOiI
COUNTY OFF
4ysical
Sw (or affir } nd subscribed bQye me Presence or Online Notarization
!'
this day of 20 Ll 6Yjl� j�l,` �(s
l i
Name of person making statement,
Personally Known' OR Prorkticed Identifii ation -
M
Type c f eritification Produced ` L
(Signature of Notary Public -State of Florida
,,� vba-., SHUNTAVIOUSMCNEIL
Commission No. 2146eal) ;=°jam%.. Nct rq Public - State of Florida
h� .
"•t_=�� Commission it GG 921954
..
My Comm. Expires Oct 21, 2G23
3onded through National Notary Awl,
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