HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �_ Z Z Permit Number: _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 2� -t-N 4+1 n-n\.r\v\\ 1 A l (\ �
Property Tax ID #: - _) n /-D- -f - 1 -1 5U-C) Lot No.
Site Plan Name: C1) Y M0 — Block No.
Project Name: CDC )r()
DETAILED DESCRIPTION OF WORD;
New Electrical Meter Second Electrical •Meter
11 CONSTRUCTION INFORMATION:
(Affidavit required)
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 A Roof � y t 2-. Pitch
Total Sq. Ft of Construction: QU Sq. Ft. of First Floor: C��q
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height: Z5
OWNER/LESSEE:
)he'
CONTRACTOR:
Name 10, e
Address: Sf die A fi V
Name:
Company:
City: State:
Zip Code: �%} Fax:
Address: I
City: P Ir Y tate:
Phone No. 9 3 ---1 E-
Zip Code: � � Fax:
Mail t "1
Phone No .
Fill in fee simple Title Holder on next page (if different
E-Mail G- wa b '
from the Owner listed above)
State or County License __�) t `-I 12__
-� �• ��••+�•�• •�•• •� +-- - ••.vc, a nca Jnvw wvuce or wmmencemenc is requirea.
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 MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
4-
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Applicable
UVVIVtK/ 4UIM I KALI UK AI-F-IUVIT: 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 and applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 IerldPr nr an attnrnav hafnra rnmmant-incr Ail,rL -, r.,...,r.dt.,...,,..... ni +:_ _t _._ _
--------------- ---.._-. ..........,,.. v.w. I I I IG 1 11.0 11 IClfl.
Signature of Contracto uilder as app icable
STATE OF FLORIna
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
this _?_C�Iay of 20_ZZby
Physical Presence or Online Notarization
wl' � nw s
Name of person making statement.
Personally Known OR Produced Identification
Type o Identification Produced
(' Notary Pu lic- Nate of Florida)
Commission No, (Seal)
KATHERINE HAVENS
MY COMMISSION #HH199309
EXPIRES: DEC 04, 2025
Bonded through 1 st State Insurance
REVIEWS
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REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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