HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �i)2� Permit Number:
Building Permit Application
Planning and Development Services \7,
Building and Code Regulation Division Commercial Residential l�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: r
4
Address:® �t�ci S l v
Property Tax ID #: L 3 "`� ('— �' o C)C) Lot No. 1
Site Plan Name: Block No.
Project Name:
LI'm oye'�� re
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit— check all that apply:
,Mechanical ,_ Gas Tank " Gas Piping _ Shutters _ Windows/Doors Pond
T Electric _ Plumbing —Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: I - Sq. Ft. of First Floor: a 5-1
Cost of Construction: $i g%o Utilities:. —Sewer —Septic Building Height:
00
Name LCc. LCCt n O Name: t r�iVl LU1 v isle Z
Address: 3 of Company: r ,ray
City: fC-� Stater Address:6 S M W 6
Zip Code: 3 zt,'t S-1 Fax: City: 611 — State:
Phone No. E- Zip Code: 'a 5 ( 11 Fax:
Mail: Phone No gj2;2-k
Fill in fee simple Title Holder on next page (if different E-Mail P r0 rOG r e-r d V7 wit I com
from the Owner listed above) State or eounty License CC // 3 �2n I
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:
Not Applicable
NfORTGAGE 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:
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 an 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 lencla t or an attornev before commencing work or recording your Notice of Commencement.
Signature bf Onfractor - o - wner Builder as applicable
STATE OF FLORIDA
COUNTY OF 1 LDS®p-r t'i(o i�-
Sworn to (or affir ) and subscribed before me of
Physical Presence or Online
Notarization
this C? day of 2017-by
0
Name of person making statement.
Known OR Produced Identification
WAY
�? _ - .
Cristal Nunez
Comm.014015760
Personally _
Ty p o lde ti icatio aduced
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: OCL 24, M24
Bohr& TW Aaron Notary
( ign ur Nat ry ublic- to of Florida)
Commission No.�Q (Seal)
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