HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO
��MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U�2-c' y�Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential A/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
01`A kKX'1VA Masv.r
PROPOSED IMPROVEMENT LOCATION:
Address:9(9-b CYc )Wd 2 K Lin, I9f- Luc iP . z . aEffk
Property Tax ID #: _53o?"j� ` -1 -D010-9 _ Lot No._�_______
Site Plan Name: f'W 1$ CAA AWL R iU f�P>('J ID-1_ ,��Di� 1r,1-' 1 � Block No.
Project Name: ftyxCILSY ]%_Ji? r I Y�
New Electrical Meter rJ6 Second Electrical Meter iV IA (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
—Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Name
City:
Zip Code: jFax:Phone No.Q"+('+(M a i 1: m
— Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
—Roof Pitch
Utilities: _ Sewer _ Septic
CONTRACTOR:
Name: '�1
Company:(
State: Tk- Addre J
-ate City: ,
E- Zip code:
AW C, Ccyv\ Phone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
_ Fax:��
I- q LigLf
l !F
E-Mail y '�WAtk
State or County license
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
It value of HAVG is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: -�— Not Applicable I MORTGAGE COMPANY: '� Not Applicable
Name: !
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 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 an posted on the jobsite before the first inspection. If you intend to obtain financing, consult
With I der_ r ain attorney/before commencing work or recordin your Notice of Commencement.
Signature of Contras or - Owner Builder as applicable
STATE OF FLORIDA,,,i
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or online Notarization
this �L day of . , 20 7by
Name of person making statement.
Personally Known / OR Produced Identification
Type of Identification Produced
(si a)
;�K'i� ,.. JULIE JANE µCCAULEY
Cam Notary Public - State off
d��' µy Comm. Expires Oct t, 1024
Sonded through National Not
Assn.
REVIEWS FRONT ZONING SUPE RVISOR PLANS VEGETATION ! SEA TURTLE �, MANGROVE.
CC�un11rER REVIfiW REVIEW REVIEW REVIEW REVIEW - - REVIEW
-D-ATE—
RECRIVCD_.. _ _._..__....._�.._.... .-.,. ....
COMPLETED —_� .�_
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