HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPL CABLE INrF1O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l�Z Z �i� Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial V/ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 9O-?
Property Tax ID #:
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Site Plan Name:
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Project Name:
DETAILED DESCRIPTION OF WORK:
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'2- 6 & A L. 6. 5- V -"w L 7 A LL_
Lot No.
Block No.
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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 -5 Pitch
Total Sq. Ft of Construction: a i 1 o o Sq. Ft. of First Floor:
Cost of Construction: $ C7, S, O U Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ,'M rW " / -7
Name: '1;N E. i
Address: 902JI-162cW1/V0 D!q
City: w U7CGM /./VSDn! ((.,7,0v,D State: F:c,
Zip Code: 3 4 5 4 9 Fax:
Phone No. E-
Company: AI Y 6�1.0,4 61f11VA,
Address: J `? G O tZ r4r A VE *7
City:`%e Iz D Bj Ck,1,+ State:rL
Zip Code: 2 1 � D Fax:
Phone No _71-Z 9 53� 7 Z
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail C- $ 1. /*? y j ,ro 6-rig 4 AA-rat-7 u r,
State or County License
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
L Cou ty and poste the jobsite before the first inspection. If you intend to obtain financing, consult
Altlend r or an ne efore commencing work or recording our Notice of Commencement.
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Signat re of Contractor - or Owner B Ider as applicable
STAT OF FLORIDA
COUNTY OF
Sword to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of 202-2—by
Name of person making statement.
i��✓r}
MAXIi�IE REYES
Personally Known ( OR Produced Identification
ry Public -State of Florida
Type of Identification Produced
mission # GG 340921
E111
Commission Expires
July 09, 2023
(Signature of Notary Public- State of Florida)
1 ��'� 1
Commission No5(Seal)
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