HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: u Permit Number:
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: 9e VOr-
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
11
DETAILED DESCRIPTION OF WORK:
1 ,mil
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: f
Cost of Construction: $
Generator
Lot No.
Block No.
Windows/Doors _ Pond
Roof 731 1 Pitch
Sq. Ft. of First Floor: G
Utilities: —Sewer _Septic Building Height: ZC1
OWNER/LESSEE:
CONTRACTOR:
Name f
Name:
Address: �"�
Company: LML61
Q
City: TN) tr y c.g. State:
Zip Code: , 92- Fax:
Phone No. E-
Address: ;512
25Tn s- 4 SW
City: 1 ityu ia)-encn State:
Zip Code: 32—q (j Fax:
Phone No S Q
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail i I OI UA
State or County License
0f -7
11 Va1uc u1 wnsLruc[iun is z3uu or more, a KrwKutu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: _ of Applicable
Name:
DESIGNER/ENGINEER: ��ot Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: _ Phone:
State:
Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip: _ Phone:
Applicable
vvV 1v1MK/ I KA%.I UK AFtIUV1 I : 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 or an attornev before rnmmanring work nr rcr nrrlina.,n,•r ni„+;, , ,,.F.
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it
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY
OF� �/�%�/
Sworn to (or affirmed) and subscribed befog me of
thisday of 2Q%�—by
/� Physical Presence or Online Notarization
I Cr1.!�y l
1 •�
Name of person making statement.
Perso all Known OR Produced Identification
e of I 'fi to oduced
u rYoKNo ry P u b I i ate rida)
Commission No. (Seal)
o,Y•yo KATHERINE HAVENS
MY COMMISSION #HH199309
EXPIRES: DEC 04, 2025
Bonded through 1st State Insurance
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