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HomeMy WebLinkAboutBuilding Permit ApplicationAdL Ant All APPLICABPE INF7 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number:C,� "T 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: Address: q-71L— Property Tax ID #: 3 O oo 52 0 L)C) Lot No. Site Plan Name: Block No. Project Name: &tA 42' 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 Windows/Doors Pond Electric Plumbing Sprinklers — Generator Roof Pitch Total Sq. Ft of Construction: O Sq. Ft. of First Floor: Cost of Construction:$ Utilities: —Sewer —Septic Building Height: Name Name: Addr s:q _4< �Company: City: &A-s. StatetL. Address: Zip Code: Fax: City: State: Phone Np. E- Zip Code: Fax: Mai 16SA6tp6o,�hone No Fill in fee simple Title Holder on next page (if different E-Mail 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. DESIGNER/ENGINEER: - Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: State: Address: City: State: City: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: �L_ -1. �_A :....L.. I I..ii.... f nr�ll`7*0/'i OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to ootain a perrrnl. w LIIC WVI N OII.. 11 �•--___. 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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult work or rarnirding vour Notice of Commencement. with lender or efore commencin Signature2oL0 rger/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF 'E;6 iAA- W cs e / Sworn or affirmed) �n� subscribed before me of V Physical Presence or Online Notarization ©C /Z- this'�dayof 20_p4by 4?C.1ncc5 Name of person making statement. Personally Known V OR Produced Identification Type of Identif' tion Produced (Signature ofXN Public- State of Florida) 410 p4,. Nomry stems a Floem Commission IoZ� (Seal) ;� N U^aQra dnsft %Expkm U51NW2255 127153 as REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE REVIEW MANGROVE REVIEW COUNTER REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev 5120121