HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a Permit Number:
D.
'' Building Permit Application
Planning and DevelopMent Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue„ Fort Pierre FL 34982
Phone: (772) 462-1$53 Fax: (772) 462-1578 CBDG Funding
PERMITAPPLI 'TION FOR:;ii t�.yn Crc c U
Address: I)-iy tip= 1�Ctfller� �� f11 �/
4
Property Tax ID t1: '-t"`1r�'+ - C+7i ' �C% ' Q rX ` I Lot No.
Site Plan Name: �r l 1 rt PVl C «^�+t d!C[ t i Block No.
Project Name:
dcL� J2 4W R-eYLCL l d cJ
r
New Electrical Meter! Second Electrical Meter (Affidavit required)
Additional work to !performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Winddoows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator of Pitch
Total Sq. Ft of Constryctilon: (o3i)t� qquRoSq. Ft. of First Floor: t0 3c;L)
Cost of Construction: iS 10� a(oL: Utilities: _Sewer _Septic Building Height:
Name: Cam- ✓e-
Name - ! C '
Addres,{:
! he.✓
Company: tCzl" • rt.jhe, tt�al��
may; ' State:
Zip Code: q w I Fax:
Phone No. - L4 - � 3W E-
Address: i4 `dam
City: GtUe�-✓L _State: f-L-
Zip Code: 34(q `I Fax: 1 ? �S R
Phone No ti a- Z1�G-�f�.
Mail:' �I
f✓ 'v' 4(I • -�- L'cwt
Fill in fee simple Title Holder o ext page (if different
from the Owner listed above)
E-Mail_P I/NL1'ec- kki' ItV.''�'s(
state or County License ��f• C-
If value of construction is 25oo or more, a RECORDED Notice of Commencement is required.
If value of HAVC is S7,51100 or more, a RECORDED Notice of Commencement is required.
t'r�•'t'/�5
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Pone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
i
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 reppresentation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any alpplirable 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 toyour property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and postedgn the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an atorPSey before commencing work or recording your Notice of Commencement
ntroctor- or - Owner Builder as applicable
STATE OF FLO�t��ID�A
COUNTY OF �i�(Lu
Sworn to (or affirtr ed) and subscribed before me of
Physical Presence or _ Online Notarization
this\, daty of 1fL.1c� 202Yby
C e—
Name of person makingstatement.
Personally Known OR Produced Identification
Type of Iden ' ion Produr,gd
6,
(Signature of Notary Public- S to
Commission No. 11 (Seal
PublicTHERAate of
r` Notary Public Slate E Flontla
Commission n GG ZOZ301
Foflded
MyComm.ExpiresApr1,2022
through National Notary Assn.
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