HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Applica#ion
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 X K
CBDG Funding
PERMIT APPLICATION FOR:
—4�'iUi'Yd,�jl r`4
PROPOSED IMPROVEMENT LOCATION:
Address:
P C
Property Tax IDSite Plan Name: --�E2Q a fJ Lot No... •
Project Name: Block No.
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas rank _
Gas Piping _ Shutters Windows/Doors
Pond
— Electric _ Plumbing —
Sprinklers — Generator Roof
Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cast of Construction: $ 4
Utilities: Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name '�
Name:
Address: 3
q Company: - 50Um
City:':�
State: 7� Address: S _ s
cc t�oi+IS
Zip Code: Fax:
city k ej T sf-, J �' o tL- State: ` l
Phone No. -a - '-20
E- Zip Code: Fax:
Mail d
m Phone No �'2 -
Fill in fee simple Title Holder on next page
f different E-Mail =C '�-
from the Owner listed above)
State or County License
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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:
Utb1bIVtR/ENGINEIER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 es, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Y u failur o Record a Notice of Commencement may result in paying twice for
improvements to your pe y. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted o e jobsite before the first inspection. If you intend to obtain financing, consult
h lender or an attorne a re circling your Notice of Commencement.
S nature of Contracto or - Owne Builder as ap 'cable
STA F FLORIDA
COON �-5'F l .. _ .
Sworn to (or affirmed) and subscribed before me�X Physical Presence or A( Online Notarization
this _Z0 day of 20.21 11 by
Name of person making statement.
Personally Known )� OR Produced Identification
Type of Identhcation Produced --
Public-State of Florida
Commission No. j ' (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
r }14.r, NOtMy Ubk Stale of Florida
Lynda A Hadley
MY a t< Fxp res 1 1612M 2B4A32
SUPERVISOR I PLANS VEGETATION I SEA TURTLE I MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW