HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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J
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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 CBDG Funding
PERMIT APPLICATION FOR: FUA-r,b\ (lG
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Q MPR "ENT LOCATION:
n
Address: `lam I t �1 t Lti L2 [ ` t _
Property Tax ID #: (�� �� ( - CDC' 6 LJ L C C Lot No.-ZL4-_
Site Plan Name: Block No.
Project Name: �-Ac��e -�i
DETAILED DESCRIPTION OF WORK:
Lrl-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
(Affidavit required)
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ ( -1C_
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
( % o Utilities: Sewer _ Septic Building Height:
OWNERf LESSEE: ' =
Name- C -- (t� vG
Address:
City: iT'�i '�,6�- '�— State: Ft —
Zip Code: -aAAJ�5( Fax:
Phone No.-�-7-:2- - S- L-� �Lk) E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:L 1 ��-
Address: l� CA`C' �'7JV'
City: State:
Zip Coder Z-i Fax:
Phone No �1' ��
E-Mail C3' VG _' cx� � CL&k
State or County License 1"G�C`-L 136G
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State:
— Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK ano III bLd I1a LIVII d� II W11-OLUU.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
t r 1A, rL nr rornMina vniir Nntirp of Commencement.
wltn lenuer Ur dI LL�UIIIC 17CI UlU t.V i I I ii��•�� - - -- -
Irid
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORID/$
COUNTY OF
Swor to (or affirmed and subscribed before me of Z' Physical Presence or Online Notarization
to
this of f 20ea by
Name of person making statement.
Personally Known OR Produce entification
Type of,ld,"tifirion Produced
(Sig ture of NSLof FloriKATHRYN
POCK R
Notary Public • State of Florida
Commission Noal) =' KW Commission tr HH 025227
�ovtti4'' My Comm. Expires Nov 21, 2024
Bonded through National Notary Assn.
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