HomeMy WebLinkAboutBuilding application app, updatedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
' Planning and Development Services Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: A
Property Tax lD#._�n Cc-InLot No.
:..
Site Plan Name: -- - —
Project Name;
Block No. ~
DETAILED DESCRIPTION OF WORK:
-------------
Ctrt� rn sue! �i e)A�
cam- hem °" `� �-� '':&)i n I 1
�.r'w rnc�: �
New Electrical Meter Second Electrical Meter rUt3 ,s
(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 q-
- — Roof � IZPitch
Total Sq. Ft of Construction: 2'500,
Sq. Ft. of First Floor:
Cost of construction: $ / Z- 57(04 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name .� r� ,'v t 4 Y
i (2- Li ��cz^ Name:
Address:(.y,.. V ;; Company:
City' -' fit (- �` 1' r' o State: Address:
Zip Code 2,As$ Fax:
City: 7 ►-( V _ state: j—d—
Phone No._''1�2 - 233Z
E- Zip Code: �� _ Fax:
Mail: Phone No 27 Z- I/[� L' - P yZ(;)
Fill in fee simple Title Holder on next page (if different E-Mail P� \lk\e_Wk)1AAlY60t 6
from the Owner listed above) �` , cc
State or County License %�(� � �5"7 3�'q _
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 INFORMATinN.
DESIGNER/ENGINEER:
Name:
Address:
City:
ZIP: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_-_- Not Applicable
State:
Not Applicable
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.
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 an . 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.
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
With let9der or an attorney befork commencing work or recording our Notice of Commencement.
/' _.
- or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
SWOT to (or affirmed) and subscribed before me of ,
this> `>' a of �,- 20Zt by
Physical Presence or Online Notarization
. Y'c n —
l
r'
Name of person ma ang�ment,
Personally Known OR Produced Identification
Type"f Identification Produced r
(Signature of Notary Public- Stat of Florida)
Commission No. (Seal)
REVIEWS REVIEWS I FRONT
COUNTER
DATE
RECEIVED
E
;"«'M hoe .,
FELICIA LYNE WILKIN
Notary Public - State of Florida
o;
Commission;, HH 160538
My Comm. Expires Sep a. 2025
Bonded
through National Notary Assn.
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