HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:� � Permit Number:
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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: 9V C"
PROPOSED IMPROVEMENT LOCATION:
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Address: Z
Property Tax ID#: , (✓-L C') 1 u-1 Lot No. �
Site Plan Name: Block No. �
Project Name:
DETAILED DESCRIPTION O.F WORK:
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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 � Windows/Doors � Pond
Electric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ / Utilities: —Sewer Septic Building Height:
OWNER/LESSEE;-_.. CONTRACTOR: .
Name��I,dyk4- t��Y JL� ( +/ a i Name: ;�v Qt:� Ci.r�o�d �
Address: a v,-
�LQIL ;: � Company. o
City:b vLc6 Stater Addres "tc
Zip Code: Fax: City: State:
Phone No. 2• '7 f. 1 1 11 E- Zip Code- Fax:
Mail: Phone No�12 )�1
Fill in fee simple Title Holder on next page(if different E-Mail La+AS 4(e
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: TNot 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 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 nonresidential 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
with lender or an attorne before commen cing work or recording our Notice of Commencement.
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Signature o ontractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to(or affix ed)and subscribed before me of Physical Presence or Online Notarization
this day of lf,,_ 20 Z7 by
Name of person making statement.
Person Ily Known `� OR Produced Identification
Type o Identific ' Produc
( nature of Notary Public-State of Florida) \ ririir/
Commission No. )�C"_15 (Seal) �.``,\\�PR pir�ve�''•,
10115/2025
Lauren Marie Scott
REVIEWS FRONT ZONING-r, Commission
�'9 5i$,ff6Q42 4Q7�P,�ANS VEGETATION SEA'TURTLE MANGROVE
COUNTER REVIEW ",, REVIEW �I-VIEW REVIEW REVIEW REVIEW
DATE _ - - �� -
RECEIVED / �����u�,iu���`�\\
DATE
COMPLETED
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