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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1-10-22All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: )acoa Permit Number: Building Permit Application Planning and DevelopmentServices �� 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:© PROPOSED IMPROVEMENT LOCATION: Address: Property Tax ID - Z Lot No.�� Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: 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: c) = G Sq. Ft. of First Floor: `"1 1 GOO Cost of Construction: o ao Utilities: _ Sewer _ Septic Building Height: _LO-" OWNER/LESSEE: Name & Address:2 Arbor Ave City: _ I?Qv4 S+, L' u e j e� State: 1: L- Zip Code: Gj Fax: — Phone N�. �S�- -7 e E- Mail:�4�A1,C�11��.�C�.r Fill in fee simple Title Holder on next page (if different from the Owner listed above) CONTRACTOR: Name: Ckc1V\ Company: ni Address: 58SO City: Q �- S�-. I_ccc� State: F-4-- Zip Code: 3qC4 9yJ Fax: Phone N�( lam(, E-Mall P_ IGOtn r gi�vcctg iCGa State or County License �<;� e t '1 195 -3 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is S7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNERANGINEER Name: _ Address: City: Zip. Phone FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: Phone: —> Not Applicable MORTGAGE COMPANY: /" Not Applicable Name: State: Not Applicable Address: City: State: Zip: Phone: BONDING COMPANY: Name: Address: City: Zip: Phone: -%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 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 with lender r at me ore commencing work or recording our Notice of Commencement. Signature of CoUtractor - OP'- Owner Builder as applicable STATE OF FLORIDA COUNTY OF 2C)C± . -r. LL eCi' Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization this 10 day of TCA r 2i�by '' r,t k>i Name of person making statement, Personally Known ✓ OR produced Identification Type of Identification Produced (Si of Notary Commission No. REVIEWS FRONT COUNTER DATE RECEIVED DATE COMPLETED of Florida) (Seal) ZONING REVIEW Notary Public State of Florida ;p Denise Robbins MY Commission GG 280183 p►nf Expires 1112812Q22 SUPERVISOR I PLANS I VEGETATION SEA TURTLE I MANGROVE REVIEW REVIEW I REVIEW REVIEW REVIEW