HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
( YY buc�u
Q '� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential____ZC_
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: �1ndfSl l� r�i2171e�-�
Address:
Property Tax ID
Site Plan Name
Project Name:.
Lot No. 3
Block No. _L9__
DETAILE® DESCRIPTIQN OF WORK ,
winS� I,rlrnxx �2P. c Sipe
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION .IN FORMATION:
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 , Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 3 f Utilities: _ Sewer _ Septic
Building Height:
OU�/Pd�;R�
TSSfrEi
GQNTF3ACTOR•
Name o(JA
Name: KtrV_ Y`rIL7�Qot1
Address:
company:tYMfYn.1 �� iPc� 1 r_
city�jC��% �p State: f ]
Zip Code: ?)(4C6__2_ Fax:
Phone No. 51p.1- JgL4-L{Ol U E-
Address: iy �j I n I A)CAh Q[
City: Q—iroon reC State:
Zip Code: L1CD3 Fax:
Phone No SU1-1414-yt)ln
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mailrly �M07t1r a njo* .ex�eriMlmr ,
State or County License C Q_Z 13?, 21 17-
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.
SURucTlo tC�f�l 11I3ltNFORMATIQIV: 1
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Applicable I BONDING COMPANY:
Name:
Address:
City:
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 s- ociation 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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Contractor - or - rBuilder asapplicable
STATE OF FLORIDA
COUNTY OF ?G\m T�eS a'
Sworn to (or affirmed d subscribed before me of
Physical Presence or Online Notarization
this ��'8ayof = .2Q2�by
_
Name of person making statement.
Personally Known FOR Produced Identification
;p►i'�'\. LILIANMORE-LANA
da
i commission # HH
€'y: Notary Public-statLNotary
Type of Identification Produced
v,wry.• My Comm. Expires O25ed
through Nadanai ssn.
(Signs r o Public- State of Florida)
Commission No. (Seal)
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DATE
RECEIVED
DATE
COMPLETED
KeV 1Uf12/21