HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:An
Building Permit Application sf.LUcie
Planning and Development Services Co
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Building and Code Regulation Division Commercial Residential K
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: tp 10 eGt-kc) S-t -ti -PLC=et,� Fi' 3'-019L
Property Tax ID #: .3q03 50-2- 02-&V (7q� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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"7 U D•i� ?� S 1tJt� 150 tnl isl,ES AND -b
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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 .3 j\'2 Pitch
4kliz
Total Sq. Ft of Construction: Lit+jpp Sq. Ft. of First Floor:
Cost of Construction: $ __ All 5-W. Utilities: _ Sewer _ Septic Building Height: 1 S:oe
OWNER%LESSEE: CONTRACTOR:
Name 1.6+Ztt'L -rofrt wt►ctt aL. srE2 Name: Sz�vEti
Address: toto ec\.k Company:r'�s;�,F,��c�„
City: f=T JRev_C� State: FL Address: 3Z1t A t= A&3V, z- INQ t
Zip Code: 3Liq,9 Z Fax: City: Fi State: _EL_
Phone No. 6(o 2-4 R 5-7 1 `J E- � Zip Code: 3rtcj5% Z Fax:
Mail: Phone No 6 `t-1
Fill in fee simple Title Holder on next page (if different E-Mail Cis YZcr, =wi - (19D Gan.4l4--Co111
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.
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SUPPLEMENTAL CO! Sl`-R-0 l.Al f ix3 #AT1Q S
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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: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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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 p ed n the 'obsite before the first inspection. If you intend to obtain financing, consult
with lenclipqor a attor ore c mmencing work or recording your Notice of Commencement.
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Signature of Co actor - o plicable
STATE OF FLORIDA
COUNTY OF S� L,u4-�
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Sworn to (or affirmed)and subscribed before me of Physical Presence or Online Notarization
this /1�1 day of 202 y
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Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
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(Signature of Notary Public- St to of Florida)
ZZOZ '90 AienjgaA
Commission No. (Seal) sajidx3 u0issiww00 Aye
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