HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
1Y .i l
c LL 6° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: j
I PROPOSED IMPROVEMENT LOCATION: I
Address: [ I
Property Tax ID #: 3LH Q • -s� ' W 8 2 • CUD • 3
Site Plan Name:
Project Name: L
New Electrical Meter Second Electrical Meter.
Lot No. 3
Block No (05
f CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
—Mechanical __.. Gas Tank Gas Piping _ Shutters _ Windows oors
Electric — Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $� I 1lJou
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Pond
Pitch
OWNER,/LESSEE:
CONTRACTOR:
Name
Addr � h C
Name: (�
Company:tru
Addres q,5f
City; oState
Zip Code: [ Fax:
Phone No. T12. (02 ( (07109
City: c te- State:
Zip Code: I Fax:
Phone No Z Zt �2�0
E-Mail
State or County License 2�0
E-Mail: a k L2Q-@--Rcr5l ICE tn
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of commencement is requires.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA c,� I'
STATE OF FLORIDA I Imo.
COUNTY OF V�LC J
COUNTY OF
Swop -color affirmed) and subscribed before me of
Swo o (or affirmed) and subscribed before me
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V P sical Pre n e or Online Notarizati n� .,
this-1 day of 2021Z by
this day a 2022
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