HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datt�e: I ��j-���� 21'11$,r" �Z Permit Number:
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r . Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
J1Pk0FOSED IMPROVEMENT LOCATION:
Address: �� I Q 39
Property Tax ID#: - S Lot No.
Site Plan Name: va CV3 l Block No.
Project Name:Woodmjo-) U0t
ETAILED DESCRIPTION OF WORK:
aC>ut
I
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank ,Gas Piping _Shutters Windows/Doors _Pond
Electric :Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ l 005 Utilities: _Sewer _Septic Building Height:
WNER/LESSEE: CONTRACTOR:
Name i Name:_ 1►'a+�u�� Rc�&t•tlS
Address: J• L, k-dA I Company: S
City: State: Address: W
Zip Code:3 G Fax: Clty:Vp-c-o 4Q--C'6\ State:
Phone No. 103 I - y E- Zip Code: 3 2-9(o 2 Fax:
Mail:1�1c i,�rro �� g1rl a CA f`1 Phone No 1,Z" 1}3 Y O
Fill in fee simple Title Holder on next page(if different E•Mail dou QC •t,Ot-�
from the Owner listed above) State or County license c�1 4
If value of construction Is 2500 or more,a RECORDED Notice of Commencement Is required.
If value of HAVC Is S7,500 or more,a RECORDED Notice of Commencement Is required.
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'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: v 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: —Not 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.
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 au 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 p sted on the jobsite before the first inspection. If you intend to obtain financing,consult
with lender or anArttorney before commencin work or recordin our Notice of Commencement.
Sign ui of nt actor-or-Owner Builder as applicable
ST TE OF FLORIDA
COUNTY OF n
Sworn o(or affirmed)and subscribed before`m�"e of Physical Presence or Online Notarization
this�day of�CL�I 20LZby
Name of person malting statement.
PersopqaU4 Known OR Pro Identification
Typ of Id tification Produc
I
(Signature o o ry lic,
*s
Commission o.
.
itPy',yj0ceui �i`
REVIEWS FRONT SUPERVISOR PLANS VEGETATION 5EATURTIE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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