HomeMy WebLinkAboutSt Lucie Building App 2All APPLICAB ,7INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR.,
PROPOSED IMPROVEMENT LOCATION:
Address: Io 0
Property Tax ID #:
Site Plan Name:
Project Name:
Lot
Vock No.
I DETAILED DESCRIPTION OF WORK: I
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New Electrical Meter Second Electrical Meter (Affidavit required)
I 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 Pitch
Total Sq. Ft of Construction: 67 17 Sq. Ft. of First Floor:
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Cost of Construction: 1440 6&90 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Y-t/ W
Address�__La
City State:
Zip Code: ax:
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Name: (SE le"17al ARo2, k;
Com pa ny: pazh:r?�'- zve-
Addre
city: State:
Zip Code:
Phone No S2 ?e,;2
Mail: D 1p-
Fill in fe�simple Title Holder on next page (if different
from the Owner listed above)
E-mail
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. 11
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMILE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 attornev before commencine work or recording vniar NntirP of (.nrnrnPnrPmPnt
Signature of Contractor - or -Owner tinder as applicable
STATE OF FLORIDA _ ,^ _7
COUNTY OF ('c t�'�tD tc'
Swop ✓
to (or affirmed) and subscribed befog me of Physical Presence or Online Notarization
this ' �;i day of } to A�� r )_ 20��by
Name of person making statement.
J
Personally Known V OR Produced Identification
Type of Identification Produced
t b v '—
(Signature of Notary Public- State of Florida)
it� <isY �� •. CYNTHIA WARE
Commission No (Seal) •`. Notary Public . State of Florida
�: Commission N 44 944730
or ° My Comm. Expires Jim 7, 2024
Bonded through National Notary Assn.
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