HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1- 21- 22 Permit Number:
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P `` 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 CBDC7 Funding
PERMIT APPLICATION FOR: (.&)
Pft®PD%D..IMPRONEINENT LOCATION:
Address: 41 ' 0� -� 2-
Property Tax ID#: 3LA�!� -i,5O�" OC�L4Q-0 - 2- Lot No. n Site Plan Name: Block No.
Project Name: e�S d t(lP
DETAILED DESCRIPTION OF WORK:
44 n
?P
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 X—Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
-
Cost of Construction:$ 4. LDq Z Utilities: —Sewer _Septic Building Height:
OUrMER�LE55E,E, CONTRACTOR:
Name Name: av-
Address: Company: n
City:�C �lp�P State: Address: l e�5f�1�� byte Wcxl 4-. t &
Zip Code: IQ$`L Fax: City: yi1CPP�AC. rec State: FI
Phone No. E- Zip Code: ?>?)q(D3 Fax:
Mail: Phone No f5to1-uuu-yQ1U
Fill in fee simple Title Holder on next page(if different E-Mail lm o fa YY10
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
11 value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
7-1
SUP,RLE1lVIENTALGONS3KUCTIONL1EN•LAWINFORMi TION:
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 BONDING COMPANY: XNot 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.
1 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 any 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 lender or an attorne before ommencin work or recordin our Notice of Commencement.
Signature of Contractor- r- ner Builder as applicable
STATE OF FLORIDA
COUNTY OF �G�M I7rs+C�n
Sworr��(or affirmed and subscribed before
�,�/ e of Physical Presence or_Online Notarization
this a of 20
I-'1(-y Ir(1LM�: N —
Name of person making statement.
Personally Known -""OR Produced Identification 'P' ° Notary Public-state of Ftorida
`7 Commission A HH 187012
Type of Identification Produced os�; my Comm.Expires Oct 15,2025
Bonded through Nationai Notary Assn.
(Signs r o Public-State of Florida)
Commission No. (Seal)
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