HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
° yr Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: `N QS rCC�
Address: ``l rIC
wvVV I _
Property Tax ID #: ��— I �2� ll��J Lot No.
Site Plan Name: Block No.
Project Name: VG1,0 (� nd
New Electrical Meter Second Electrical Meter
M ME MAC
M Fix
Additt* nal 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: $ 51 n / Utilities: —Sewer —Septic
Building Height:
Name (� Name:/� i�• ossl�l►
Address: J'P (Qv) _ Company: 64' 0 n Air Wr I61 T� fS7! )
City: .r State: Address: ���sb 1 17�
Zip Code: Fax:-7 2-4 0-q7-7-9 City: Stater
Phone No.�%%T3q�Vy� 'gZip Code Fax:77Z_-,2_)q 7
E-Mail: P70t r LY COO ( / .r2--i— Phone No 72 i� q!�=gl)Z5
Fill in fee simple Title Holder on next page ( if different E-Mail /rl`�ne
from the Owner listed above) State or ounty License (,
_J
If value of construction is 2500 or more, a KtLUKUW Notice QT LUM1T1CI1l C1 11C l l l o icyvi c.•.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip: _
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK ano mstaiiduri a� iiiui-01,cu.
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
structure. ture. Please consult nwithpyour applicable
lome Owners Owners
Association
Association and rreview your deed or any restrictions ylaws or and covenants that wh ch may at or pply. obit such
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. i
i
Sig f Owrter Lessee/Contractor as Agent for Owner
STATE OF FLORIDt f� k le -
COUNTY OF .�
Swop to (or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization
this day of 2022 by
n
Name of person aking statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi
4P
Commission No.
NOWry PubhC State of Florida
F Cra�a ,GA roasman
My issan GG 983089
n� E■wres 05/10/2024
License H
v� J
STATE OF FLORID
COUNTY OF
SwNn to (or affirmed) and subscribed before me of
..// Ph sical Prespence or Online Notarization
this day of 2021 by
n
Name of person9Aking&tatem�ent.�
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi
Syr � Notary Pubhc State of Fonda
ommission No. , Cra(�, 6 ossrnan
My Cammi sion GG 983069
• ram Expires 05/10/2024
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