HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 1 2- Permit Number: _
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' x ' ° Y Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #::+t 0 j_s C �C ;(� - I Lot No.�
Site Plan Name: \jc) na;�_ Cie `v�-" Block No.
Project Name: VC-) 11 U s fnc-
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WHITIMIA11ce
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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 Roof 3 R_ " /-I2•Pitch
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Total Sq. Ft of Construction: an Sq. Ft. of First Floor: Cl c5y_�
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
711
OWN ER/LESSEE:
CONTRACTOR:
Name ,. Zvi
Address:
Name: c
Company: a 1 .S
l y
City: ( State:
Zip Co e: Fax:
Phone No. E-
Address: i���
City: State:
Zip Code: ij Fax:
Phone No _1___1 -3
E-Mail y
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
It value of construction is Z500 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.
SUPPLEMENTAL. CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
,Not Applicable
MORTGAGE COMPANY:
Name:
of Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
of Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
t Applicable
Address:
City:
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 anly applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 lende r an attorney before commencing work or recording our Notice of Commencement.
hj;1'101A� '\( t" I I
Sig ature of Contractor - or- Owner ui der as applicable
STATE OF FLORIDA
COUNTY OF 2EIlic
Sworn to (or affirmed and subscribed before me of
Physical Presence or Online Notarization
this day of 20 Dbb
_'1i
,n
d R
Name of person maki g statement.
Personally Known OR Produced Identification
Type of Identifi
(Signature o Nota lic- State of Florida)
Commission No. (Seal)
NE HAVENS
ON
#HH199S09
EC 04, 2025
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lst State lnwanca
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Rev 10/12/21