HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll 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:
Address:
Property Tax ID #: I3
Site Plan Na
Project Name: �� -C� -L-
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No. )C>
Block No. C-eo
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric —Plumbing Sprinklers 14--6enerator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ au Utilities: —Sewer J Septic Building Height:
OWNER/LESSEE;, CONTRACTOR
Names. s - Name: (n?Cho k(1
Address:610S:V{ C� lc) l�,'l Company:r-I d 1 r� '� LL
City: H(,A V?-', Y, StateAddress:
Zip Code: 1 say Fax:: City: ��
Phone No.`232 • aJr� )
)-' (�� Flo E- Zip Code: "Qs ( Fax:
Mail: Phone Nofflro� p.(0 t(--A1
Fill in fee simple Title Holder on next page (if different E-Mail A
from the Owner listed above) State or County L' ense�C''�'�,,( nA�—
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:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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.
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 anV 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 job ' e before the first inspection. If you intend to obtain financing, consult
,e,ith lanrler nr an nttnrnpu hpfnr mmencinE work or recordine vour Notice of Commencement.
/ I
Signature of Contractor or - 0 ner Builder as applicable
STATE OF FL0R!
COUNTY OF C 1
Sworn to (or aff ed) and subscribed before me of Physical Presence or _ Online Notarization
this�A day oof,) ar)by
r �20M�
tl'l�ICle\ �7CIY Il dV-)
l.J/
Name of person making statement.
Personally Known �S OR Produced Identification
Identificati n Produced
LIL( �ffr+
SI a�
(Signature of Notary Public- att=f Florida)
..
Commission No. (Seal) `*,..
Gi1NC/SI.VE�`
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