HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ` g h
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: e5�6z�1
g-r.LLar ,
r RECEIVED
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D - Building Permit Application-
Planning and Development Services JAPE 2 5. 71141t
Building-and Code Regulation Division Commercial Residential Permittinc Putt ;p,7.
fit.1nrric C"r,,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: S
Property Tax ID#: �o(,3 03 Lot No.
Site Plan Name: Block No..
Project Name:
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New Electrical Meter ' Second Electrical Meter (Affidavit required)
50
W:ON
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: $ G z Utilities: —Sewer _Septic' Building Height:
-
Name a V G 6 �P.P(��
Address:
City: State:
Zip Code: Fax: City: ,
Phone No. Zip Coae: - _ - -- ---;
E-Mail: Phone f`
Fill in fee simple Title Holder on next page if different E-Mail_
from the Owner listed above) State or Countycn
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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NOR 'V
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 gosted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I der r an tt e�y before commencing work or recording our Notice of Commencement.
6�y a
Signititure of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF. !'f
Sworn o or affirmeec,l and subscribed before me of �sical Presence or Online Notarization
this day of �,� 2?Zby
Name of person making statement.
Personally Known OR Produce, lqentification
Type of Identification Produced-
(Signature of Notary Public-State of Florid
Commission No. ASeal)
`�OtPAY PVC, -
ER SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
RE ®�� rlda D REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVE Feb ue y oon oXpi es�
DATE
COMPLETED Raw
Rev 2 21