HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r-
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Date: Permit Number:
96 r.L LLMO - QFC�1
„-9• . -. � • :.==�'.= Building Permit Application
Planning and Development Services �4ejN �11
Building and Code Regulation Division Commercial
Residential Colo
v of
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ,
x a.
Address: /• ,$��,� (����c1/e �� rr-''
P tY
Site Plan Name: Block No
Project Name:
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ORN
WRINI
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2can AV
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors i Pond
i
Electric _Plumbing Sprinklers _Generator _Roof Pitch
7
Total Sq. Ft of Construction: %�,0 S q• Ft. of First Floor:
Cost of Construction: $ �'j C)L Utilities: —Sewer _Septic Building Height: _
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Name J Name: +✓.- �,
Address: `�j� I�� rru kz 00" Company: �
City: � c�NGty State:,,' ;Address: 2Z�3 vC(zl I�r �
zip Code: J `/�y< pa* City: �cJ��1 Sta e:
Phone No. �2 — 3N'2 Zip Code: 3 �f�'� Fax: c�
1: Phone No 22.2/
Fill in fee simple Title Holder on next page ( if different E-mail I' A�!t ,O, "
from the Owner listed above) State or County License
dam.
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.
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DESIGNER/ENGINEER: _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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Cont(actor as Agent for Owner
STATE OF FLORID
COUNTY OF_��// I a
Sworn to or affirmed)and subscribed before me of y Physical Presence or Online Notarization
this�day of ZVq)L%t/_ 20 li21aq
Name of person making statement. /
Personally Known OR Produced Id ntification
Type of Identification Produced
(Signature o Notary Public-State Flori a)
_ 4
Commission No.- (Seal) �� Yp`�,, :EAHER BURFO
;Stalorida Notar.rCsion # GC
mmissinuary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev S 2 21
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