HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONe
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All APPLICABLE INFO MUST BE COMPI - =) FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number:
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:I ° Building Permit Application `tG�
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Planning and Development Services Ca�
Building and Code Regulation Division Commercial Residentiaf,�i X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: �900 . yPi��� /�� f % ' r/Ea e 0; �� 3.3el9
Property Tax ID #:
Lot No.
Site Plan Name: Block No.
Project Name:'
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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 _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Seq. Ft of Construction: Sq. Ft. of First Floor:
oC`st of onstruction: $ Utilities: —Sewer _ Septic Building Height:
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Name ZiZoAl.-Pew
Name:
Address: y909P �' D.Z�� /��.
Company:
City: f-"T &a -mil- State: r-1
Address:
Zip Code: 3��'�3'/ Fax: ,r/1�
City: State:
Phone No. _10aip -d-104y E-
Zip Code: Fax:
Mail: L.,G'Alm Q 7A . /l%e 1 ^
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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.
�SUPPL`ENI�ENTA 'CONST �'U ° IQ LIEN � :.�W IN'��4RNIATION
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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 TITLEHOLDER: _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 any 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 posted on -the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorneybefore commencing work or recordingour Notice of Commencement.
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nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S,J" L ,�x.,s
Sworn to (or affirmed) and subscribed before me of
�al Presence or Online Notarization
this day of . 20_ by
Name of person making statement.
/
c/
Personally Known OR Produced Identification
Type of Identification Produced � V
(Signature of Notary Public- tate of Florida)
Commission No. (Seal)
HEATHER BURFORD
StatA of Florida -Notary
&_tOs
Fublic
Commission # �� 1g321 �
MY Commission Expires
February 06, 2022
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