HomeMy WebLinkAboutBuilding Permit ApplicationA APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . o a�b— Permit Number: Q
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V/
2300 Vlrginlo Avenue, Fort Pierce FL, 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: F L e CTR I CA L
PROPQSEDA
II�fIPROVEMFNT LOCATIa:N; n.;.
Address:
Property Tax ID #: 1 Lot No. fir(
Site Plan Name: 1nI�CT �1'1�`} Block No.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CQNSTRUCTI°ONINFOR:MATION;` '.
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters i Windows/Doors : Pond
_ Electric — Plumbing _ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction: Sq. R. of First Floor:
Cost of Construction: $ .tig� 6d Utilities: _ Sewer _Septic Building Height:
CC�NTRACTQR
s z;
Name mil. is QS trC�1Qy
Address: yRUI- .inn ASP
City: iPlel'C,.2, State: —VA.
Zip Code: 39191% 2,_ Fax:
Phone No. % - 314-- CiQ5'1
E-Mail:
Fill in fee simple Title Holder on next page*( if different
from the Owner listed above)
Company: 1
Address: tA
City: _ �lR C_,� Stater -
Zip Code: �3�1� Fax:
Phone No
E-Mail Q� (� � - Q
r'Yl
�
State or ounty License EC I?Xo0 t(D` ,
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.
Not Applicable
Name:_
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: 'Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not 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 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 your Notice of Commencement.
Signatur o caner/ es ee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �ZN . Lucie
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 3 day of hPln _ 202.; by
�M HAT11
Name of person makings ement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signs re of Notary P lic- S at o
:o ,jda� )Notary Public State. of
Margaret E Montep
Commission No. y c_ a�MI�iy Commission GG 2
"E'xoires 06/05/2022
Signa o Contractor/License Holder
STATE OF FLORIDA
COUNTY OF -434 . L.ucl-e-
Swor to (or affirmed) and subscribed before me of
Physical Presgvc or Online Notarization
this 3 day of t- 202:: by
Name of person making s ement.
Personally Known 1011 Produced Identification
Type of Identification
Produced
lure of Notary Public- State of lor* 4
� Notary Public State
Margaret E Monte
ission No.C-TC-IJI14Q 9() +y c, . )MY Commission GG
Expires 06/05/2022
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DATE
COMPLETED