HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O
IV° ' Building Permit Application
Planning and Development Services /l
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; �"711 '1✓(a�iu �)C1't)'t'�
Property Tax ID#;IS aC tW�005A
Site Plan Name:
n (
Me;9 ��'� t�
Y.. X, Project Name: � t`'my, i
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No.�_
Block No.
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: Sq, Ft, of First Floor:
Cost of Construction:$ ocmo.00 Utilities: _Sewer _Septic Building Height:
Zip Code: Fax:
Phone N85 — 49
Fill in
fee
simple
Title Holder on
from
the
Owner
listed above)
Name: ►)p(A�C�1
Company:�[< �tn�►
State: `'� Address: a
City: &ii�i
E- ZIP Code;
t
�rAi► . COm Phone No,5Q
page (if different E-Mall. VQL
State or County
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.
Fax:
a
a®
MORTGAGE COMPANY:
Name:
_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
State: _
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER:
Name:
— Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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,
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no re resentation that Is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an Y ap l�cable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult witth 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 attorney before commencing work or recording your Notice of Commencement.
as Agent for Pwner
STATE OF FLO A
COUNTY OF �1ACl'°. COU-'n�
Swor o (o affirrped) andand sP bscribed before ye of Physical Presence or _ online Notarization
this dayof CYl 20c,� b
Name of person mak
Personally Known -
Type of Identifica ' r
7
(signature
�9 Notary
Produced identification
(Seal}
MY COMMISSION N HH 2O3974
IXPIRES: Deceroher2, 2026
rMed TbN fklery PubNc Undemrnars
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FRONT
ZONING
SUPERVISOR
PLANS
SEATUR7LE
MANGROVE
COUNTER
REVIEW
REVIEW I
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(VEGETATION
REVIEW
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