HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZJ2.02_Z_
U Permit Number:
s .r�N
G 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: OtVCc�
I PROPOSED IMPROVEMENT LOCATION:
Address: ahnS+<:)n �
Property Tax ID #: ' SC2- CQ'5 00C Lot No. l !�3
Site Plan Name:- 111 Block No.
Project Name:
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 XRoof 41 i itch
Total Sq. Ft of Construction: i C7 Sq
Cost of Construction: Utilities:
Ft. of First Floor: 1931
_ Sewer _ Septic Building Height: 2-0
OWNER/LESSEE:
CONTRACTOR:
Name l v
Addr��es�ss: � � �Q� i� �c /�� /
City:T�71at�' Sm %S and State: JEv
Zip Code: Fax:
Phone No. E-
Mail:
Name:
Company: .
Address: 342L 251-Y) S tei
CL
City: ve-yL
Zip Code: .. _qL Fax:
Phone No
E-Mail
State: ELI
Fill in fee simple Title Holder on next page (if different
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of commencement is requireo.
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:
Name:
Address:
City:
Zip: Phone: _
4 Not Applicable
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender nr an attornev hefnre rnmmenring wnrk nr rprnrriincs vnur Nntire of CnmmPnrement_
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY (_ 0 C t"
OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thisday of I _, 20? by
�_iciqod P r-Ff,
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifi n o
e
(Sig o - a e of FI i a) KATHERINE HAVENS
MY COMMISSION #HH199309
Commission No. (Seal) EXPIRES: DEC 04, 2025
Bonded through 1st State Insurance
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mev lU/1L/L1